Tissue-fixing surgical instrument, tissue-fixing device, and method of fixing tissue

ABSTRACT

A surgical instrument for fastening together opposing portions of a body organ. The instrument comprises a first support for supporting the first opposing portion of the body organ, a second support opposing the first support, for supporting the second opposing portion of the body organ, and a displacement-preventing member connected to the first or second support for preventing the supports from displacing relative to each other. The member comprises a pin protruding from one of the supports and a hole formed in the other of the supports. The pin is made of thermoplastic resin. When heated, the pin is softened and deformed, whereby the first and second supports are secured to each other, fastening together the opposing portions of the body organ.

CROSS-REFERENCE TO RELATED APPLICATIONS

This is a Continuation-In-Part of application Ser. No. 08/620,364 filedMar. 22, 1996, now U.S. Pat. No. 5,797,931, which in turn is aContinuation-In-Part of application Ser. No. 08/384,210 filed Feb. 3,1995, now U.S. Pat. No. 5,658,300, which in turn is a Continuation ofapplication Ser. No. 08/072,224, filed Jun. 3, 1993 (abandoned).

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to a surgical instrument for ligating orsuturing tissues, a device for ligating or suturing tissues together,and a method of ligating or suturing tissues.

2. Description of the Related Art

Hitherto, clips applicators of the type shown in Published UnexaminedJpn. Pat. Appln. Publication No. 57-112856 have been used to ligatetubular organs such as blood vessels and bile ducts by using clips.Staplers of the type disclosed in Published Unexamined Jpn. Pat. Appln.Publication No. 3-12126 have been used to suture tubular organs such asintestines by using staples.

Most clips and staplers used for ligating and suturing tissues are madeof metal, such as titanium, which is compatible with body tissues. Clipsare known which are made of resin capable of being absorbed into bodytissues, such as polydioxanone, polylactide, or polyglycolide.

Although the clips and staples are made of metal compatible withtissues, such as titanium, they will remain as foreign bodies inpatients. Clips made of resin capable of being absorbed into bodytissues are more likely to become loose than those made of metal,because their latching or clamping force is relatively small since itresults from the elasticity of the resin.

SUMMARY OF THE INVENTION

The object of this invention is to provide a surgical instrument whichcan reliably ligate or suture tissues with devices such as clips orstaples, a device which can ligate or suture tissues steadfastly, and amethod which can reliably ligate or suture tissues.

To attained the object, there are provided the following apparatus,devices and methods according to the present invention:

A surgical instrument for fastening together opposing portions of a bodyorgan, comprising: first support means for supporting the first opposingportion of the body organ; second support means opposing the firstsupport means, for supporting the second opposing portion of the bodyorgan; displacement-preventing means connected to one of the supportmeans for preventing the support means from displacing relative to eachother, and made of thermoplastic resin which is softened when heated;and an applicator having holding means for holding at least one of thesupport means, heating means for heating and softening thedisplacement-preventing means, and operating means for deforming thedisplacement-preventing means thus softened, thereby to fix the firstand second support means in position to fasten together the opposingportions of the body organ.

A surgical device for fastening together opposing portions of a bodyorgan, comprising: first support means for supporting the first opposingportion of the body organ; second support means opposing the firstsupport means, for supporting the second opposing portion of the bodyorgan; and displacement-preventing means connected to one of the supportmeans for preventing the support means from displacing relative to eachother, and made of thermoplastic resin which is softened when heated.

A method of applying a clip to a body organ by means of an applicator,comprising the steps of: preparing a clip comprising a pair of legs anda thermally deformable member, all made of thermoplastic resin; loadingthe clip in the applicator; placing the body organ between the legs ofthe clip; heating and softening the thermally deformable member; andclosing the legs of the clip, thereby clamping the body organ.

A method of applying a fastener to body tissues by means of anapplicator, for fastening the body tissues together, comprising thesteps of: preparing a fastener made of thermoplastic resin and havinglegs; loading the fastener in the applicator; piercing the legs of thefastener through the body tissues; and heating and deforming the legs ofthe fastener, thereby fastening the body tissues together.

A method of applying a fastener and a retainer to body tissues by meansof an applicator, for fastening the body tissues together, comprisingthe steps of: preparing the fastener and the retainer, both made ofthermoplastic resin; loading the fastener and the retainer in theapplicator; piercing the legs of the fastener through the body tissues;connecting the legs of the fastener to the retainer; and heating anddeforming the legs of the fastener, thereby securing the same to theretainer, thereby fastening the body tissues together.

With the present invention it is possible to clamp a tissue with adevice made of thermoplastic resin, such as a clip or a staple, therebyachieving reliable ligation or suture of the tissue.

Additional objects and advantages of the invention will be set forth inthe description which follows, and in part will be obvious from thedescription, or may be learned by practice of the invention. The objectsand advantages of the invention may be realized and obtained by means ofthe instrumentalities and combinations particularly pointed out in theappended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of the specification, illustrate presently preferred embodiments ofthe invention, and together with the general description given above andthe detailed description of the preferred embodiments given below, serveto explain the principles of the invention.

FIG. 1 is a side view showing a clip applicator which is a firstembodiment of the present invention;

FIG. 2 is a perspective view showing a clip which is to applied by theapplication shown in FIG. 1;

FIG. 3 is a perspective view showing the clip holder of the applicatorshown in FIG. 1;

FIG. 4 is a sectional view showing a part of the clip holder of theapplicator shown in FIG. 1;

FIGS. 5A, 5B, and 5C are diagrams explaining how to operate the clipapplicator of FIG. 1;

FIG. 6 is a perspective view showing a clip to be applied by a clipapplicator according to a second embodiment of the invention;

FIG. 7 is a sectional view showing a part of the clip holder of theapplicator which is the second embodiment of this invention;

FIGS. 8A and 8B are side views showing a modification of the clip shownin FIG. 6;

FIG. 9 is a diagram showing a clip applicator according to a thirdembodiment of this invention;

FIG. 10 is a sectional view showing the distal end portion of the clipapplicator shown in FIG. 9;

FIG. 11 is a side view showing a stapler which is a fourth embodiment ofthe present invention;

FIG. 12 is an exploded view showing the clamp section of the staplerillustrated in FIG. 11;

FIG. 13 is a partially sectional view showing the anvil of the clampsection shown in FIG. 12;

FIG. 14 is a partially sectional side view showing the cartridge of theclamp section;

FIGS. 15A and 15B are diagrams explaining the operation of the staplershown in FIG. 11;

FIG. 16 is a partially sectional side view showing the distal endportion of a stapler which is a fifth embodiment of the presentinvention;

FIG. 17 is a cross-sectional view showing part of the clamp section ofthe stapler shown in FIG. 16, and explaining how to suture a tubularorgan by means of the stapler;

FIGS. 18A and 18B are perspective views, both showing the staple appliedby the stapler of FIG. 16 and also explaining how to suture a organtissue with this staple;

FIG. 19 is a partially sectional side view showing the distal endportion of a stapler which is a sixth embodiment of the presentinvention;

FIG. 20 is a perspective view showing a stapler which is a seventhembodiment of the invention;

FIG. 21 is an exploded view showing the suture section of the staplershown in FIG. 20;

FIG. 22 is an exploded view of a stapler which is applied by the staplershown in FIG. 20;

FIG. 23 is a perspective view of a stapler according to an eighthembodiment of this invention;

FIGS. 24A and 24B are cross-sectional views showing the distal endportion of the stapler shown in FIG. 23 and explaining how the staplerapplies a staple to fasten body walls together;

FIGS. 25A, 25B, and 25C are cross-sectional views showing a modificationof the stapler shown in FIG. 23;

FIG. 26 is an exploded view showing a first modification of the staplewhich is applied by the stapler shown in FIG. 12;

FIGS. 27A and 27B are sectional views of the staple shown in FIG. 26 andexplaining how the staple fastens tow tissue layers together;

FIG. 28 is an exploded view illustrating a second modification of thestaple which is applied by the stapler shown in FIG. 12;

FIG. 29 is an exploded view showing a third modification of the staplewhich is applied by the stapler shown in FIG. 12;

FIGS. 30A and 30B are perspective views showing a fourth modification ofthe stapler which is applied by the stapler;

FIG. 31 is a view explaining how the stapler shown in FIGS. 30A and 30Bis used to ligate a tubular organ;

FIG. 32A is a diagram schematically showing a clip applicator which is aninth embodiment of the present invention;

FIG. 32B is a side view of the distal end portion of the clip applicatorshown in FIG. 32A;

FIG. 33 is a schematic representation of a stapler which is a tenthembodiment of the present invention;

FIG. 34 is a perspective view showing the distal end portion of thestapler shown in FIG. 33;

FIG. 35 is an exploded view illustrating a staple which is applied bythe stapler of FIG. 33;

FIGS. 36A and 36B are diagrams explaining how the stapler of FIG. 33 isoperated to stitch together two severed parts of a tubular organ;

FIG. 37 is a plan view showing one of the two jaws of a clip applicatoraccording to an eleventh embodiment of the invention;

FIG. 38 is a side view showing the jaw shown in FIG. 37;

FIGS. 39A and 39B are diagrams explaining how a clip applicatoraccording to a twelfth embodiment of the invention apply a plurality ofclips, gathering and stitching together the tissues;

FIG. 40 is a schematic representation of a clip applicator which is athirteenth embodiment of the present invention;

FIG. 41 is a partly sectional side view showing the distal end portionof the clip applicator shown in FIG. 40;

FIG. 42 is a perspective view illustrating a clip which the applicatorof FIG. 40 is to apply;

FIGS. 43A, 43B, and 43C are diagrams explaining how the clip applicatoris used to ligate a tubular organ;

FIG. 44 is a side view of a stapler according to a fourteenth embodimentof the present invention;

FIG. 45 is an exploded view showing the distal end portion of thestapler shown in FIG. 44;

FIGS. 46A and 46B are cross-sectional view showing the distal endportions and explaining how the stapler is manipulated to apply aplurality of staples;

FIG. 47 is a perspective view showing a clip applicator which is afifteenth embodiment of the present invention;

FIG. 48 is a perspective view showing a clip applicator which is afifteenth embodiment of the present invention;

FIG. 49 is a sectional view showing the distal end portion of the clipapplicator shown in FIG. 48;

FIG. 50 is a diagram explaining how to manipulate the clip applicator ofFIG. 48;

FIG. 51 is also a diagram explaining how to manipulate the clipapplicator of FIG. 48;

FIG. 52 is a perspective view showing clips to be applied by theapplicator of FIG. 48;

FIG. 53 is a diagram explaining how to manipulate the clip applicator ofFIG. 48;

FIG. 54 is another diagram explaining how to manipulate the clipapplicator of FIG. 48;

FIG. 55 is still another diagram explaining how to manipulate the clipapplicator of FIG. 48;

FIG. 56 is a schematic representation of a stapler which is a sixteenthembodiment of this invention;

FIG. 57 is an exploded view showing the distal end portion of thestapler shown in FIG. 56;

FIG. 58 is a sectional view of the distal end portion of the staplershown in FIG. 56, explaining how the stapler applies staples;

FIG. 59 is a diagram schematically illustrating a clip applicatoraccording to a seventeenth embodiment of this invention;

FIG. 60 is a side view showing the distal end portion of the clipapplicator shown in FIG. 59;

FIG. 61 is a perspective view showing a clip to be applied by theapplicator of FIG. 59;

FIG. 62 is a perspective view showing a clip which is an eighteenthembodiment of the present invention;

FIG. 63 is a perspective view illustrating a clip which is a nineteenthembodiment of the invention;

FIG. 64 is a perspective view showing a clip which is a twentiethembodiment of this invention;

FIG. 65 is a perspective view showing a clip which is to be applied by aclip applicator according to a twenty-first embodiment of the presentinvention;

FIGS. 66A, 66B, and 66C are diagrams explaining how to apply the clip ofFIG. 65 to ligate a tubular organ;

FIG. 67 is a sectional side view showing the applicator which is thetwenty-first embodiment of the invention;

FIG. 68 is a perspective view showing a clip which is a twenty-secondembodiment of the present invention;

FIG. 69 is a perspective view illustrating the jaw of a clip applicatorwhich is a twenty-third embodiment of this invention;

FIG. 70 is a sectional view showing the jaw of FIG. 69;

FIG. 71 is a perspective view showing a clip which is a twenty-fourthembodiment of the present invention;

FIG. 72 is a perspective view illustrating a clip which is atwenty-fifth embodiment of the invention;

FIG. 73 is a side view of the clip illustrated in FIG. 72;

FIGS. 74A and 74B are cross-sectional views of the clip, taken alongline A--A in FIG. 73;

FIG. 75 is a diagram explaining how to fuse together the legs of theclip shown in FIG. 72;

FIG. 76 is a perspective view showing a clip which is a twenty-sixthembodiment of the invention;

FIG. 77 is a sectional view showing the jaws of a clip applicatoraccording to a twenty-seventh embodiment of the present invention;

FIGS. 78 and 79 are perspective views illustrating a clip applicatoraccording to a twenty-eighth embodiment of the invention;

FIG. 80A is a perspective view showing the distal end portion of a clipapplicator according to a twenty-ninth embodiment of this invention;

FIG. 80B is a plan view showing the distal end portion of theoscillation-transmitting member of the applicator shown in FIG. 80A;

FIG. 81 is a side view showing the distal end portion of the clipapplicator shown in FIG. 80A;

FIG. 82 is a plan view illustrating the distal end portion of the clipapplicator shown in FIG. 80A;

FIGS. 83 and 84 are a side view and plan view of a clip applicator whichis a thirtieth embodiment of the present invention;

FIG. 85 is a schematic representation of a clip applicator according toa thirty-first embodiment of the present invention;

FIG. 86 is a diagram schematically showing a clip applicator which is athirty-second embodiment of this invention;

FIG. 87 is a diagram schematically illustrating a clip applicatoraccording to a thirty-third embodiment of this invention;

FIGS. 88A and 88B are perspective views, both showing a clip in openstate, which is a thirty-fourth embodiment of this invention;

FIGS. 89A and 89B are perspective views, both showing the clip (FIGS.88A and 88B) in closed state;

FIG. 90 is a perspective view showing a clip in open state, which is athirty-fifth embodiment of the present invention;

FIG. 91 is a perspective view showing the clip (FIG. 90) in closedstate;

FIG. 92 is a side view illustrating a clip in open state, which is athirty-sixth embodiment of the present invention;

FIG. 93 is a side view showing the clip (FIG. 92) in closed position;

FIG. 94 is a side view showing a clip according to a thirty-seventhembodiment of the present invention;

FIG. 95 is a longitudinal sectional view showing a clip applicator whichis the thirty-seventh embodiment of the invention and which is designedto apply the clip shown in FIG. 94;

FIG. 96 is a side view illustrating the clip-holding section of theapplicator shown in FIG. 95;

FIG. 97 is a side view showing the clip (FIG. 94) which is clamping atubular organ;

FIG. 98 is a longitudinal sectional view showing a clip applicator whichis a thirty-eighth embodiment of the invention;

FIG. 99 is a side view showing a clip according to a thirty-ninthembodiment of the present invention which is applied by the clipapplicator;

FIG. 100 is a view explaining how the clip of FIG. 99 stitches togethertwo tissues;

FIG. 101 is a side view of a clip which is a fortieth embodiment of thepresent invention;

FIG. 102 is a side view of a clip which is a forty-first embodiment ofthe present invention;

FIG. 103A is a side view showing the entire clip applicator according toa forty-second embodiment of the present invention;

FIG. 103B is a side view showing a distal end portion of the applicatoraccording to the forty-second embodiment;

FIG. 103C is a plan view showing the distal end portion of theapplicator according to the forty-second embodiment;

FIG. 104A is a longitudinal cross-sectional view showing an initialstate of use of an elongated portion according to the forty-secondembodiment;

FIG. 104B is a longitudinal cross-sectional view showing a clippingstate of the elongated portion according to the forty-second embodiment;

FIG. 105 is a perspective view showing an inner structure of the distalend portion of the elongated portion according to the forty-secondembodiment;

FIG. 106A is a longitudinal cross-sectional view showing the distal endportion of the elongated portion according to the forty-secondembodiment;

FIG. 106B is a cross-sectional view cut along the line 106B--106B ofFIG. 106A;

FIG. 107 is a longitudinal cross-sectional view showing a handle portionaccording to the forty-second embodiment;

FIG. 108A is a longitudinal cross-sectional side view showing an initialstate of the handle portion according to the forty-second embodiment;

FIG. 108B is a longitudinal cross-sectional side view showing a clippingstate of the handle portion according to the forty-second embodiment;

FIG. 109 is a side view showing exploded respective portions of theapplicator according to the forty-second embodiment;

FIG. 110A is a perspective view showing a clip used for the applicatoraccording to the forty-second embodiment;

FIG. 110B is a side view showing the clip used for the applicatoraccording to the forty-second embodiment;

FIG. 111A to FIG. 111E are views explaining use procedures of theapplicator according to the forty-second embodiment;

FIG. 112A to FIG. 112B are views explaining states of use of theapplicator according to the forty-second embodiment;

FIG. 113 is a view explaining a state of use of the forty-secondembodiment;

FIG. 114 is a perspective view showing a clip and the attached portionthereof according to a modified version of the forty-second embodiment;

FIG. 115 is a side view showing a clip according to a forty-thirdembodiment;

FIG. 116A is a side view showing a clip according to a forty-fourthembodiment;

FIG. 116B is a front view showing a clip according to the forty-fourthembodiment;

FIG. 117 is a perspective view showing a distal end of an applicatoraccording to the forty-fourth embodiment;

FIG. 118A is a cross-sectional view showing an initial state of a distalend portion of the applicator according to the forty-fourth embodiment;

FIG. 118B is a cross-sectional view showing a state of use of the distalend portion of the applicator according to the forty-fourth embodiment;

FIG. 119A is a side view of a modified version of the clip according tothe forty-fourth embodiment;

FIG. 119B is a front view of the modified version of the clip accordingto the forty-fourth embodiment;

FIG. 119C is a perspective view showing the clip according to theforty-fourth embodiment;

FIG. 120 is a cross-sectional view showing a distal end portion of theapplicator according to a forty-fifth embodiment;

FIG. 121 is a perspective view showing an inner structure of the distalend portion of the applicator according to the forty-fifth embodiment;and

FIG. 122 is a cross-sectional view showing the distal end portion of theapplicator according to the forty-fifth embodiment;

FIG. 123A is a front view showing a tissue-fixing medical deviceaccording to a forty-sixth embodiment;

FIG. 123B is a side view showing the tissue-fixing medical device shownin FIG. 123A;

FIG. 124A is an enlarged front view showing the leading end of thetissue-fixing medical device shown in FIG. 123A;

FIG. 124B is a side view showing the tissue-fixing medical device shownin FIG. 124A;

FIG. 125 is a vertical side sectional view showing the leading end of anapplicator of the tissue-fixing medical device shown in FIG. 123A;

FIG. 126 is a diagram showing a first stage for fixing tissues by thetissue-fixing medical device shown in FIG. 123A;

FIG. 127 is diagram showing a second stage for fixing tissues by thetissue-fixing medical device shown in FIG. 123A;

FIG. 128 is a diagram showing a third stage for fixing tissues by thetissue-fixing medical device shown in FIG. 123A;

FIG. 129 is a diagram showing tissues fixed by the tissue-fixing medicaldevice shown in FIG. 123A;

FIG. 130A is a side view showing a modification of the tissue-fixingmedical device according to the forty-sixth embodiment;

FIG. 130B is a vertical side sectional view showing the leading end ofan applicator of the tissue-fixing medical device shown in FIG. 130A;

FIG. 131 is a side view having a partial cross sectional view of theleading end of a tissue-fixing medical device according to aforty-seventh embodiment;

FIG. 132 is a die view having a partial sectional view of the leadingend of a tissue-fixing medical device according to a forty-eighthembodiment;

FIG. 133 is a side view showing a state of the operation of thetissue-fixing medical device shown in FIG. 132;

FIG. 134 is a side view showing the leading end of a tissue-fixingmedical device according to a modification of the forty-eighthembodiment;

FIG. 135 is a side view showing a state of the operation of thetissue-fixing medical device shown in FIG. 134;

FIG. 136 is a vertical side sectional view of an operation section of atissue-fixing medical device according to a forty-ninth embodiment;

FIG. 137 is a vertical side sectional view showing a first stage of theoperation of the tissue-fixing medical device shown in FIG. 136;

FIG. 138A is a vertical side sectional view showing the tissue-fixingmedical device in the state shown in FIG. 136;

FIG. 138B is an enlarged sectional view showing the leading end of thetissue-fixing medical device in the state shown in FIG. 138A;

FIG. 139 is a vertical side sectional view of an operation section of atissue-fixing medical device according to a fiftieth embodiment;

FIG. 140 is an exploded view of the tissue-fixing medical device shownin FIG. 139;

FIG. 141A is a front view showing a first operating state of atissue-fixing medical device according to a fifty-first embodiment;

FIG. 141B is a front view showing a second operating state of thetissue-fixing medical device according to the fifty-first embodiment;

FIG. 141C is a front view showing a third operating state of thetissue-fixing medical device according to the fifty-first embodiment;

FIG. 141D is a front view showing a fourth operating state of thetissue-fixing medical device according to the fifty-first embodiment;

FIG. 142A is a vertical side sectional view of an operation section of atissue-fixing medical device according to fifty-second and fifty-thirdembodiments;

FIG. 142B is side view showing the leading end of the tissue-fixingmedical device according to the fifty-second and fifth-thirdembodiments;

FIG. 143A is a side view having a partial cut portion and showing asurgical fixing instrument according to a fifty-fourth embodiment;

FIG. 143B is a rear view of an operation section of the surgical fixinginstrument shown in FIG. 143A;

FIG. 143C is a sectional view taken along line 143C--143C shown in FIG.143A;

FIG. 144A is a vertical side sectional view of an expansion section ofthe surgical fixing instrument shown in FIG. 143A;

FIG. 144B is a sectional view taken along line 144B--144B shown in FIG.143A;

FIG. 144C is a sectional view taken along line 144C--144C shown in FIG.143A;

FIG. 144D is a sectional view taken along line 144D--144D shown in FIG.143A;

FIG. 144E is a sectional view taken along line 144E--144E shown in FIG.143A;

FIG. 145 is a vertical plan view showing an initial stage of theoperation of an elongation section of the surgical fixing instrumentshown in FIG. 143A;

FIG. 146 is a vertical side sectional view showing an initial stage ofthe operation of an elongation section of the surgical fixinginstructing shown in FIG. 143A;

FIG. 147A is a side view showing a state of a clip cartridge of thesurgical fixing instrument shown in FIG. 143A from which a fixed platehas been removed; and

FIG. 147B is a side view showing the clip cartridge of the surgicalfixing instrument shown in FIG. 143A from which the fixed plate has beenmounted.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

A clip applicator, which is a first embodiment of the present invention,will be described with reference to FIGS. 1 to 6. Of these figures, FIG.2 shows a clip 1A which the applicator 10 will apply to ligate a tubularorgan such as a blood vessel.

As shown in FIG. 2, the clip 1A has a first leg 3a (first support means)and a second leg 3b (second support means). The legs 3a and 3b arehinged to each other at a hinge portion 2. The first leg 3a has athrough hole 5. A pin 4 protrudes from the second leg 3b, extendingtoward the hole 5 of the first leg 3a. The legs 3a and 3b can abut eachother, whereby the pin 4 is fixed, relatively tight in the hole 5 of thesecond leg 3a. The legs 3a and 3b are formed integral with each other,made of thermoplastic resin which is compatible with body tissues andwhich can be absorbed thereinto.

As shown in FIG. 1, the clip applicator 10 has a sheath 11 which will beinserted an abdominal cavity through a guide tube (not shown) such as atrocar. A clip holder 12 is attached to the distal end of the sheath 11,for holding the clip 1A. As FIG. 3 shows, the clip holder 12 comprises afirst clip-holding member 13 secured to the sheath 11 and a secondclip-holding member 14 connected by a pin to the first clip-holdingmember 13. The second clip-holding member 14 can rotate about the pin,whereby the clip holder 12 is opened and closed.

Referring back to FIG. 1, an operation section 15 is connected to theproximal end of the sheath 11. The section 15 is manipulated to open andclose the clip holder 12 attached to the distal end of the sheath 11.The operation section 15 comprises a fixed handle 16 and a handle 17.The fixed handle 16 is fastened to the proximal end of the sheath 11.The handle 17 is coupled to the fixed handle 16 by a connecting pin, andcan rotate around the connecting pin. A wire 18 made of comparativelyhard material is connected at one end to the handle 17, extends throughthe sheath 11, and is connected at the other end to the proximal end ofthe second clip-holding member 14. Therefore, the handle 17 pulls thewire 18, closing the clip holder 12, when it is rotated in onedirection, and pushes the wire 18, opening the clip holder 12, when itis rotated in the opposite direction.

As can be understood from FIGS. 3 and 4, the clip 1A is held between theclip-holding members 13 and 14 of the holder 12, so that it may beinserted into an abdominal cavity and applied therein. To be morespecific, the legs 3a and 3b of the clip 1A are fitted, in part, in therecesses 13a and 14a formed in the opposing surfaces of the clip-holdingmembers 13 and 14, respectively. Hence, the holder 12 holds clip 1Asteadfastly.

As shown in FIG. 4, an electric heater 19 such as a diode or a ceramicheater 19 is embedded in that surface of the first clip-holding member13 which opposes the second clip-holing member 14. The heater 19 isconnected to one end of a power-supply cord 20, which is embedded in thefirst clip-holding member 13 and extends through the sheath 11 to theproximal end of the applicator 10. The cord 20 is connected, at itsother end, to a power supply (not shown) located outside the applicator10. The heater 19 is exposed through an escape hole 21 made in saidsurface of the first clip-holding member 13.

With reference to FIGS. 5A, 5B, and 5C, it will be described how theclip applicator 10 is operated to apply the clip 1A to ligate a tubularorgan such as a blood vessel. The clip 1A is removed from a cartridge(not shown). As shown in FIG. 5A, the clip 1A is pinched in the gapbetween the clip-holding members 13 and 14 of the clip holder 12 whichis attached to the distal end of the sheath 11.

Next, the sheath 11 is inserted into a body cavity where the tubularorgan A is located. The clip applicator 10 is manipulated, therebyplacing the tubular organ A in the gap between the legs 3a and 3b of theclip 1A as is illustrated in FIG. 5A. Then, the handle 17 is operated,rotating the second clip-holding member 14 of the clip holder 12 andthus closing the clip 1A. As a result, the pin 4 of the second leg 3b ofthe clip 1A fits into the through hole 5 of the first leg 3a, as isshown in FIG. 5B. The tubular organ A is thereby collapsed.

In this condition, an electric current is supplied from the power supply(not shown) to the heater 19 embedded in the first clip-holding member13, by either automatic operation or manual operation. The heater 19heats the tip of the pin 4 fitted in the hole 5. The tip of the pin 4 isthereby fused to the first leg 3a.

Once the pin 4 of the second leg 3b is fused to the first leg 3a, theclip 1A firmly clamps the tubular organ A. This prevents the clip 1Afrom becoming so loose as to release the tubular organ A.

Another clip applicator, which is a second embodiment of the invention,will be described with reference to FIGS. 6 and 7.

FIG. 6 shows a clip 1C used in this embodiment, and FIG. 7 shows thedistal end portion of the clip holder 12 of the clip applicator. As canbe understood from FIG. 6, the second leg 3b of the clip 1C has a claw 8at its distal end. The claw 8 is so shaped as to latch the distal end ofthe first leg 3a of the clip 1C. As shown in FIG. 7, a heater 19 islocated at the hinge portion of the clip 1C. After the clip 1C isclosed, with the claw 8 latching the distal end of the first leg 3a, theheater 19 heats and softens the hinge portion. Then, the hinge portionis cooled, whereby the clip 1C is deformed permanently, with the legs 3aand 3b fastened together firmly.

FIGS. 8A and 8B show a modification 1B of the clip 1A shown in FIG. 2.The clip 1B differs from the clip 1A in two respects. First, thatportion of the lower surface of the leg 3a which surround the hole 5 ismade of heat-resistant resin 6. Second, the pin 4 has a flaring forkedtip 7.

Even when the heat generated by the heater 19 is applied to the clip 13,the leg 3a of the clip 1B is not fused. When the clip 1B is closed byoperating the applicator 10, the two parts of the forked tip 7 are movedaway from each other and, in this condition, and thermally deformed dueto the heat generated by the heater 19. Once the forked tip 7 is sodeformed, the pin 4 is prevented from slipping out of the hole 5,whereby legs 3a and 3b of the clip 1B are connected together firmly.

A clip applicator 25 according to a third embodiment of the inventionwill be described, with reference to FIGS. 9 and 10.

As is evident from FIG. 10, a temperature sensor 26 is arranged near theheater 19 embedded in the first clip-holding member 13 of the clipholder 12. The sensor 26 is connected to a temperature-detecting circuit27 shown in FIG. 9. The temperature data the circuit 27 has obtained isinput to a control device 28. The device 28 controls a cooling-waterpump 29 and a power supply 30 in accordance with the temperature data.The control device 28 is turned on or off by operating a switch 31. Thepump 29 is connected to the proximal end portion of the sheath 11 of theapplicator 25. The cooling water can thereby be supplied from the pump29 to the clip holder 12 through the sheath 11. The clip applicator 25is identical in any other structural features to the clip applicator 10which is shown in FIG. 1.

The handle 17 is manipulated, thus closing the clip holder 12, hence,closing the clip 1A (not shown) held between the clip-holding members 13and 14. As a result, the clip 1A clamps a tubular organ (not shown).Then, the switch 31 is closed, and the control device 28 supplies asignal to the power supply 30. In response to the signal the powersupply 30 supplies a current the heater 19. The heater 19 generatesheat. The heat is applied to the pin 4 which is inserted in the hole 5of the leg 3a.

The temperature sensor 26 detects the temperature of the heater 19 andgenerates a signal representing this temperature. The signal is suppliedto the temperature-detecting circuit 27, which produces temperature datafrom the signal. The data is input to the control device 28. When thetemperature represented by the data exceeds a preset value, the circuit28 outputs a temperature control signal, which turns off the powersupply 30. The heater 19 can therefore be maintained at a temperaturewhich is higher than the glass-transition point of the pin 4 and whichis appropriate for thermally deforming the pin 4.

Upon lapse of a prescribed time after the temperature of the heater 19has reached the predetermined value, said prescribed time being longenough for the pin 4 to fuse with first leg 3a, it is detected that theclip 1A has been thermally deformed. At this time, the control device 28generates a power-supply stop signal and a pump drive signal. Thepower-supply stop signal and the pump drive signal are supplied to thepower supply 30 and the cooling-water pump 29, respectively. In responseto the stop signal, the power supply 30 stops supplying power to theheater 19. In response to the drive signal, the cooling-water pump 29operates, supplying cooling water (e.g., physiological salt solution) tothe clip holder 12 through the sheath 11. The water, thus supplied,cools the holder 12 holding the clip 1A.

Since the cooling water is supplied to the clip holder 12 and cools theclip 1A immediately after the pin 4 of the clip 1A is fused to the firstleg 3a of the clip 1A, the thermally deformed portion of the clip 1A canbe rendered rigid quickly. The clip 1A can therefore ligate the bodytissue readily, within a short period of time.

A stapler 40, which is a fourth embodiment of the present invention anddesigned to suture body tissues, will be described with reference toFIGS. 11 to 15.

As FIG. 11 shows, the stapler 40 has an insertion section 41, a clampsection 42, and an operation section 51. The insertion section 41 is asheath which is to be inserted into an abdominal cavity through aguiding instrument such as a trocar (not shown). The clamp section 42designed for clamping body tissues is secured to the distal end of theinsertion section 41.

As shown in FIG. 12, the section 42 comprises a casing 43, a cartridge44, and an anvil 45. The casing 43 is secured to the distal end of theinsertion section 41 and has an opening top. The cartridge 44 isremovably contained in the casing 43. The anvil 45 opposes the uppersurface of the cartridge 44 and can rotate to open and close the casing43. The cartridge 44 has a knife-guiding groove 46 made in the uppersurface, extending along the longitudinal axis of the casing 43. Tworectangular recesses 47 are made in the upper surface of the cartridge44, located symmetrically with respect to the knife-guiding groove 46,for receiving staple bases 57 of a stapler 56 which will be describedlater. A knife (not shown) is moved forward, along the the knife-guidinggroove 46. As is shown in FIG. 14, a plurality of gas nozzles 48 isformed in the bottom of each recess 47, for applying gas onto the staplebase 57, thereby to push the base 57 upwards. As shown in FIG. 14, thecartridge 44 has a pusher-gas passage 49 through which to supply the gasfor pushing the bases 57 upwards.

As shown in FIG. 13, a heater 50 is embedded in the lower surface of theanvil 45, which function as a stapler-holding surface. The heater 50 isused to thermally deform the tips of the staple pins 59 which standupright on the staple bases 57 set in the recesses 47.

Referring back to FIG. 11, the operation section 51 is connected to theproximal end of the insertion section 41. The operation section 51comprises an anvil-rotating handle 52 and a firing handle 53. The handle52 is manipulated to rotate the anvil 45, thereby to open and close theclamp section 42. The firing handle 53 is squeezed to let the pusher gasflow from a gas cylinder (not shown) incorporated in the section 51 intothe pusher-gas passage 49 of the cartridge 44. A power-supply cord 54,which is connected at one end to the heater 50, extends from theoperating section 51 and is connected to a power supply 55.

As FIG. 12 shows, each staple 56 comprises a staple base (first supportmeans) 57 and a plate-shaped staple cover (second support means) 58. Aplurality of staple pins 59 stand upright on the staple base 57. Thestaple cover 58 has a plurality of holes 60 for receiving the staplepins 59. All components of each stable 56 are made of resin which isabsorbable into body tissues.

It will be described how to apply the staples 56 by the stapler tostitch body tissues together. First, the cartridge 44 containing thebases of the staples 56 is placed in the casing 43 of the clamp section42, and the staple covers 58 are fitted in the anvil 45. Then, the clampsection 42 containing the staples 56 is attached to the distal end ofthe insertion section 41 of the stapler 40. The insertion section 41 isguided into a body cavity, thus locating the clamp section 42 at adesired position within the body cavity. The anvil-rotating handle 52 ismanipulated, thereby opening the anvil 45. The clamp section 42 is moveduntil the body tissues B are clamped placed between the cartridge 44 andthe anvil 45.

In this condition, the firing handle 53 is squeezed, making the pushergas flow from the gas cylinder (not shown) into the recesses 47 made inthe upper surface of the cartridge 44 through the pusher-gas passage 49cut in the the cartridge 44. The gas pushes up the staple bases 57placed in the recesses 47. As the staple bases 57 are thus pushedupwards, the staple pins 59 standing upright on the bases 57 pierce thetissues B and fit into the holes 60 of the staple covers 58.

Then, a current is supplied from the power supply 55 to the heater 50.The heater 50 heats the tips of the staple pins 59 protruding from theholes 60 of the staple covers 58. The tips of the pins 59 fuse with theupper surface of the staple cover 58 as is shown in FIG. 15B whichillustrates the body tissues B already cut with the knife (not shown)incorporated in the stapler 40.

As described above, the heater 50 embedded in the anvil 45 can fuse thetips of the staple pins 59, fastening the pins 59 to the upper surfaceof the staple covers 58. The staple bases 57 can thereby coupled to thestaple covers 58 steadfastly. As a result, the body tissues B can bereliably fixed or clamped between each staple base 57 and the staplecover 58 associated therewith. Since the staple bases 57 and the staplecovers 58 are made of resin which can be absorbed into tissues, theywill be absorbed into the tissues B after the suture of the body tissuesB.

Another stapler 70, which is a fifth embodiment of this invention, willbe described with reference to FIGS. 16, 17, and 18.

The stapler 70 is designed to apply a staple 65 of the type shown inFIG. 18. The staple 65 comprises two net-like strips (support means) 66and 67 and a plurality of staple pins (fastening means) 68. The strips66 and 67 are made of heat-resistant material which can be absorbed intobody tissues. The staple pins 68 are made of resin which is absorbableinto body tissues. Each pin 68 has a proximal end 68a having a largerdiameter than the remaining portion.

FIG. 16 is a partially sectional side view of the distal end portion ofthe stapler 70. As this figure shows, a clamp section 71 is connected tothe distal end of the sheath of the stapler 70. The clamp section 71 isdesigned to clamp a tubular organ A such as a blood vessel. The section71 comprises a cartridge 72 and an anvil 73. The cartridge 72, which isremovable, contains the staple pins 68 and has pushers 74 and a pusherhandle 75 for pushing the pushers 74 upwards, one after another. Theanvil 73 is connected to the sheath and opposes the staple-holdingsurface (i.e., the upper surface) of the cartridge 72.

A heater 76 is arranged in the staple-holding surface (i.e., the lowersurface) of the anvil 73, for heating and fusing the tips of the staplepins 68. As shown in FIG. 17, the net-like strips 66 and 67 are mountedon the staple-holding surface of the cartridge 72 and that of the anvil73, respectively. The staple pins 68 are arranged in rows extendingparallel to the axis of the cartridge 72. The pusher bar 75 extend alsoparallel to the axis of the cartridge 72 and can be moved back andforth. A knife 77 is mounted on the staple-holding surface of thecartridge 72. The knife 77 can be moved back and forth along the axis ofthe cartridge 72. When moved forward, it can cut a tubular organ Aclamped between the cartridge 72 and the anvil 73.

To suture the tubular organ A with the staple 65 by means of the stapler70, thus structured, the distal end portion of the stapler 70 is guidedinto a body cavity containing the tubular organ A. The clamp section 71is then manipulated, thereby clamping the organ A between the cartridge72 and the anvil 73. Next, the pusher bar 75 is slit forward by remotecontrol, pushing the pushers 74 upwards one after another. The staplepins 73 are thereby pushed up, piercing the net-like strips 66, theorgan A, and the net-like strip 67 and abutting the staple-holdingsurface of the anvil 73, as is shown in FIG. 17. In this condition, theheater 76 is turned on, heating and fusing the tips of the staple pins68. As a result, the tips of the pins 68 collapse between the anvil 73and the net-like strip 67 as shown in FIG. 18B. At the same time thetips of the pins 68 are so fused, the knife 77 is moved forward, thuscutting the tubular organ A along the row of of staple pins 68.

In this way, the stapler 70 can suture the tubular organ A with thestaple 65, as steadfastly as does the stapler 40 shown in FIGS. 11 to14.

Still another stapler, which is a sixth embodiment of the presentinvention, will be described with reference to FIG. 19.

Referring to FIG. 19, the clamp section of this stapler comprises acartridge 72, an anvil 73, a pusher 74, a pusher bar 75, and a knife 77,which are identical to those of the stapler shown in FIG. 17. The clampsection has a heater 78 which can slide back and forth in the passageformed within the anvil 73, along the axis of the anvil 73. The heater78 is used to heat the tips of U-shaped staples 80 made of resin whichis absorbable into body tissues. A staple-receiving plate 79 is mountedon the lower surface of the anvil 73. The plate 79 is made ofheat-resistant material and has a plurality of through holes 81 forreceiving the tips of the staples 80.

This stapler is manipulated in the same way as the stapler. The slidingheater 78 located in the anvil 73 can locally heat the tips of eachstaple 80 partly inserted in the through holes 81 of thestaple-receiving plate 79. As a result, the tips of the staples 80 arefused onto the upper surface of the plate 79, whereby the stapler cansuture the tubular organ A with the staple 80, as steadfastly as doesthe stapler 70 (FIG. 16) which is the fifth embodiment of the invention.

A circular stapler 90, which is a seventh embodiment of this invention,will be described with reference to FIGS. 20, 21, and 22.

FIG. 22 is an exploded view showing a staple 85 which this stapler 90apply to stitch tubular organs together. The staple 85 comprises aring-shaped base 86, a plurality of pins 87, and a ring-shaped cover 89.The base 86 consists of four arcuate segments. The pins 87 protrude fromthe base 86 in parallel to one another and spaced apart in thecircumferential direction of the base 86. The cover 89 also consists offour arcuate segments, each having the same number of pin-receivingholes 88. All components of the staple 85 are made of thermoplasticresin which can be absorbed into body tissues or which is compatiblewith body tissues.

As is shown in FIG. 20, the circular stapler 90 comprises an insertionsection 91 which is to be inserted into a tubular organ A, a suturesection 92 connected to the distal end of the insertion section 91, andan operation section 93 connected to the proximal end of the insertionsection 91. The suture section 92 comprises a staple-feeding section 94and a staple-receiving section 96, as is illustrated in FIG. 21. Thestaple-feeding section 94 is fastened to the insertion section 91. Thestaple-receiving section 96 is coupled to the distal end of the section94 by a connecting bolt 95.

The staple-feeding section 94 contains a staple pusher 97 for pushingthe staple base 86 forward, and a cylindrical cutter 98 for cutting offany unnecessary portions of the tubular organ A after the two severedparts of the organ A are stitched together. Both the staple pusher 97and the circular cutter 98 can be driven back and forth by means of ahydraulic cylinder (not shown). As shown in FIG. 20, a handle 99 isconnected to the operation section 93, for operating the hydrauliccylinder.

Referring to FIG. 21, the staple-receiving section 96 has astaple-holding surface 100 for holding the pins 87 which protrude fromthe base 86 pushed forward from the staple-feeding section 94. Formed inthe surface 100 is a staple-holding groove 101 designed for holding thering-shaped cover 89 of the staple 85. A heater 102 is placed at thebottom of the groove 101, for heating the tips of the staple pins 87.

The staple-feeding section 94 has a screw hole 103 which is cut in itsthe distal end and which is coaxial with the section 94. The connectingbolt 95 is set in screw engagement with the hole 103, coupling thestaple-receiving section 96 to the distal end of the section 94.Arranged within the screw hole 103 is an electrically conductive spring104, which extends through the connecting bolt 95 and is connected tothe heater 102, for supplying electric power to the heater 102.

The stapler 90, thus constructed, is operated as follows, in order tostitch together two severed parts of the tubular organ A. As shown inFIG. 20, the insertion section 92 is inserted into the tubular organ Auntil the staple-feeding section 94 and the staple-receiving section 96are placed within said two severed parts, respectively. In thiscondition, the severed edges of the organ parts, which have shrunk andcollapsed, are located between the sections 94 and 96.

The handle 99 is squeezed, driving the staple is pusher 97 forward. Thestaple base 86 is thereby pushed forward, whereby the staple pins 87pierce the severed edges of the organ parts, are then inserted into thepin-receiving holes 88 of the ring-shaped cover 89, and finally abut onthe heater 102 arranged in the staple-receiving section 96. In thiscondition, an electric current is supplied to the heater 102, whichheats the tips of the pins 87. The tips of the pins 87 are thereby fusedonto the ring-shaped cover 89. As a result, the severed parts of thetubular organ A are fastened together. Thereafter, the cylindricalcutter 98 is thrust forward, cutting the unnecessary portions from thesutured parts.

The circular stapler 90 can, therefore, achieve the same advantages asthe stapler (FIG. 19) which is the sixth embodiment of the presentinvention.

Another stapler 110, which is an eighth embodiment of the invention,will be described with reference to FIG. 23 and FIGS. 24A and 24B. AsFIG. 23 shows, this stapler 110 comprises an insertion section 111 andan operation section 112. The operation section 112 is connected to theproximal end of the insertion section 111, and has a handle 113, aheater switch 114, and a water-supply switch 115. A power supply 116 anda water-supplying device 117 are connected to the operation section 112.

FIGS. 24A and 24B are cross-sectional views showing the internalstructure of the distal end portion of the insertion section 111. Thedistal end portion of the section 111 contains a generally M-shapedstaple 118. The staple 118 is made of thermoplastic resin which isabsorbable into, or is compatible with, body tissues. The staple 118 hasclaws 119a and 119a, each at one end, which are sharp enough to piecebody walls A and which can fasten body walls together.

The distal end portion of the insertion section 111 contains a staplepusher 121 which can be driven back and forth along the axis of theinsertion section 111, for pushing the staple 118 from the insertionsection 111 through a staple-feeding hole 120 made in the distal end ofthe insertion section 111. A heater 122 is attached to the distal end ofthe staple pusher 121. The heater 122 is connected to the power supply116 by a cable 123 and has, in its front, a recess 122a. The recess 112ahas the same shape as the staple 118, for holding the staple 118.

The insertion section 111 contains a tube 124, through which thewater-supplying device 117 supplies cooling water to the distal end ofthe insertion section 111, thereby to cool the staple 118. An anvil 125is located in the distal end of the section 111. The anvil 125 has aflange for supporting the center portion of the staple 118. The flangefunctions to hold the center portion of the staple 118.

The stapler 110, thus constructed, is operated as follows, in order tofasten the body walls A together. First, the insertion section 111 is sopositioned that the the staple-feeding hole 120 is directed to the bodywalls A to be stitched together. Then, the handle 113 of the operationsection 112 is squeezed, driving the staple pusher 121 to the distal endof the section 111. The pusher 121 subsequently pushes the centerportion of the staple 118 against the anvil 125 as is shown in FIG. 24A.Pushed further, the staple 118 is bent or closed, whereby its claws 119aand 119b pierce the body walls A and finally abut on each other,piercing the walls A at other portions, as is illustrated in FIG. 24B.

Next, the heater switch 114 of the operation section 112 is pushed,supplying an electric current to the heater 122 through the cable 123.The heater 122 heats the staple 118, removing the bending strain fromthe staple 118. Thereafter, the water-supply switch 115 of the operationsection 112 is pushed, whereby the water-supplying device 117 suppliescooling water to the distal end of the insertion section 111. The staple118 is thereby cooled and hence deformed permanently. At this time, thestaple 118 is held by the anvil 125. To release the staple 118 from theanvil 125, it suffices to move the staple 118 sideways to a positionwhere the staple slips out of the anvil 125.

Since the stapler 110 heats and cools the staple 118, thus deforming thesame permanently as described above, it fasten the walls A to eachother, both readily and reliably. In addition, the use of the generallyM-shaped staple 118 makes it possible to suture flat body tissuestogether.

FIGS. 25A, 25B, and 25C show a modification of the stapler 110 accordingto the eighth embodiment of the invention, and explain how this staplerapplies a staple 118 to stitch body walls A together. The modificationdiffers from the stapler 110 in that a staple holder 126 is removablyattached to the front of the heater 122. Both the staple 118 and thestaple holder 126 are made of resin which is absorbable into, or iscompatible with, body tissues.

FIG. 26 and FIGS. 27A and 27B show a staple which can be applied by thestapler 40 shown in FIG. 12. As is shown in these figures, the staplecomprises a base 127, a plurality of pins 128 protruding downwards fromthe lower surface of the base 127, and a pin-holding plate 129 havingthrough holes 130. The holes 130 have a diameter larger than that of thepins 128. The components of the staple 127 are all made of materialswhich can be absorbed into body tissues. More precisely, the pins 128are made of material having a softening point higher than the materialof the pin-holding plate 129. As is shown in FIG. 27A, a heater 50 isused to heat and thermally deform the lower ends of the pins 128.

After inserted in the through holes 130 of the pin-holding plate 129,the pins 128 of the staple 127 are fused at their tips, whereby thetissue layers clamped, as if riveted, between the base 127 and thepin-holding plate 129. The tissue layers are thereby fastened to eachother steadfastly. Since the plate 129 shields the heat emanating fromthe heater 50, thermal damages, if any, to the body tissues can beminimized. Further, since the staple pins 128 have no projections orstepped portions, they do not damage the body tissues so much.

The stapler 40 can apply other types of staplers which are shown inFIGS. 28 and 29. The staple shown in FIG. 28 differs from the staplershown in FIG. 27 in that a plurality of rings 131 replace the plate 129.The staple shown in FIG. 29 differs from the stapler shown in FIG. 27 inthat a meshed plate 132 having grids replaces the plate 129.

FIGS. 30A and 30B shows a staple 133 of so-called "magic tape type." Thestaple 133 has a number of arch-shaped projections 134 which protrudefrom a half of the lower side as shown in FIG. 30A, and also a number ofJ-shaped projections 135 protrude from the entire upper side. Each ofthe J-shaped projections 135 can catch one arch-shaped projection 134.The staple 133 is made of resin which can be absorbed into, or iscompatible with, body tissues.

How to ligate a tubular organ (e.g., a blood vessel) by using the staple133 will be described, with reference to FIG. 31. First, the staple 133is wound tight around the severed edge portions of a tubular organ 137,thereby tying them together. Then, a heater 138 is put in contact withthe arch-shaped projections 134, fusing the projections 134 to the upperside of the staple 133, whereby the tubular organ 137 is ligated. Thestaple 133 wound around the tubular organ 137 is a strip having a firstportion and a second portion which hold the opposing parts of the organ137, respectively.

The magic-tape type staple 133 can be applied to ligate tubular organsof various sizes, and can adjust the tightening the organs to anydesired degree.

A clip applicator 140, which is a ninth embodiment of this invention,will be described with reference to FIGS. 32A and 32B. This applicator140 is designed to apply a clip 152 of the same type as shown in FIG. 6.The distal end of the applicator 140 contains a Langevin-type ultrasonicoscillator 141 which has a horn at its tip. Connected to the distal endof the oscillator 141 is an oscillation-transmitting member 142. Themember 142 comprises an oscillation-transmitting body 143 and a tip 144.The body 143 has a threaded hole. The tip 144 has a threaded portion setin screw engagement with the threaded hole of the body 143.

An L-shaped member 145 is located near the tip 144 of theoscillation-transmitting member 142. The member 145 has a distal endportion 145a located in front of the tip 144, spaced apart therefrom bya predetermined distance. The L-shaped member 145 is connected at rearend to a support pipe 146, which in turn is fastened to a sliding member147. The sliding member 147 is slidably mounted on the distal endportion of a case 148 containing the ultrasonic oscillator 141. The case148 has a grip 149 at which the applicator 140 can be held by hand. Theultrasonic oscillator 141 is connected to a drive circuit 150, which isconnected to a drive signal generator 151.

In operation, the drive circuit 150 amplifies a drive signal thegenerator 151 has output. The amplified drive signal is supplied to theultrasonic oscillator 141. Driven by the signal, the oscillator 141generate ultrasonic oscillation, which is applied to theoscillation-transmitting body 143 and hence to the tip 144. The body 143has such a length that the oscillation amplitude is maximal (i.e., withthe anti-node located) at the end face of the tip 144.

The applicator 140 is operated as follows, in order to apply the clip152. First, the clip 152 is clamped between the tip 144 and the distalend portion 145a of the L-shaped member 145. Next, the sliding member147 is slid toward the case 148, moving the portion 145a toward the tip144. The clip 152 is thereby collapsed, with its legs contacting eachother at their tips. As a result, the clip 152 constricts a tubularorgan (not shown) placed between the legs with an appropriate force. Inother words, the clip 152 held between the tip 144 and the L-shapedmember 145 clamps the organ. In this condition, the ultrasonicoscillator 141 is driven, applying ultrasonic oscillation to the tip 144for a predetermined time. During this time, the contacting legs of theclip 152 undergo dynamic friction, generating heat and eventually fusingto each other. As a result, the clip made of resin closes permanently,clipping the tubular body steadfastly.

A stapler 155, which is a tenth embodiment of this invention, will bedescribed with reference to FIGS. 33, 34, 35, 36A, 36B.

As FIG. 33 shows, this stapler 155 comprises a sheath 156 to be insertedinto a tubular organ such as intestine, a stapling section 157 coupledto the distal end of the sheath 156, and an operation section 158connected to the proximal end of the sheath 156.

As clearly shown in FIG. 34, the stapling section 157 comprises a hollowcylindrical housing 159 atttached to the distal end of the sheath 156,and an anvil 160 located at the front of the housing 159. As shown inFIG. 33, the housing 159 contains a staple pusher 161 and a cylindricalcutter 162, which can be moved back and forth. The stable pusher 161,which is a hollow cylinder, is used to push a first ring 173 (laterdescribed) toward the anvil 160. The cutter 162 is provided for cuttingoff the unnecessary portions of the tubular organ after the two severedparts of the organ have been stapled together.

As is shown in FIG. 35, the staple to be applied by the stapler 155comprises two rings 173 and 175. The first ring 173 has a plurality ofstyluses 174 which protrude in parallel to one another and spaced apartin the circumferential direction of the ring 173. The second ring 175 isremovably held in the annular groove (not shown) cut in the back of theanvil 160. The ring 175 has as many holes 176 as the styluses 174, intowhich the styluses 174 will be inserted. Both rings 173 and 175 are madeof resin which is absorbable absorbed into, or is compatible with, bodytissues.

Referring back to FIG. 33, the operation section 158 comprises a housing163 and a sliding member 164. The housing 163 is fixed to the sheath156, and the sliding member 164 can move back and forth within thehousing 163. A handle 166a is formed integral with the housing 163 andextending downward therefrom. Another handle 166b is formed integralwith the sliding member 164 and extends downwards therefrom. Bothhandles 166a and 166b can be grasped so that the handle 116 be movedtoward the handle 166a, thereby to slide the member 164 forward againstthe bias of a compression spring 165 contained in the sliding member164.

As can be understood from FIG. 33, the sliding member 164 is a hollowmember and contains an ultrasonic oscillator 167. The oscillator 167 isbiased onto the inner front wall of the sliding member 164 by means of acompression spring 168. A hollow oscillation-transmitting member 169,which is a hollow cylinder, is coupled by a horn to the front end of theoscillator 167. The distal end of the member 169 is coupled to the rearend of the staple pusher 161, whereby the oscillation of the oscillator167 is transmitted to the staple pusher 161 via the horn and the member169. An anvil shaft 170 extends through the oscillation-transmittingmember 169. The shaft 170 has a threaded end protruding from the housing159 and set in screw engagement with a knob 171 which is rotatablyconnected to the rear end of the housing 159. When the knob 171 isturned in one direction and the other, the anvil shaft 170 is moved backand forth, whereby the space between the hollow cylindrical housing 159and the anvil 160. The ultrasonic oscillator 167 is connected by a leadline 177 to an oscillator-driving circuit 178, which in turn isconnected to a drive signal generator 179.

The stapler 155, thus constructed, is operated as follows, to apply thestaple shown in FIG. 35. First, the knob 171 is turned in a prescribeddirection, moving the anvil 160 toward the hollow cylindrical housing159, thereby clamping the abutting ends of two severed parts of atubular organs 180 between the housing 159 and the anvil 160 as is shownin FIG. 36A. Then, the handles 166a and 166b are gripped, moving thehandle 166b and hence sliding the member 164 forward. As a result, thefirst ring 173 of the staple is pushed out of the hollow cylindricalhousing 159, whereby the styluses 174 of the first ring 173 pierce theabutting walls of the severed parts of a tubular organ 180 and fit intothe holes 176 of the second ring 175. Thus, the severed parts of theorgan 180 are fastened together.

Next, the ultrasonic oscillator 167 is driven, generating ultrasonicoscillation. The oscillation-transmitting member 169 transmits theoscillation to the staple pusher 161 and hence to the first ring 173.The styluses 174 of the first ring 173, which are inserted in the holes176 of the second ring 175, undergo dynamic friction with the secondring 175. The styluses 174 are thereby heated and fuse, whereby therings 173 and 175 are connected to each other. Thereafter, the handle166b is further pulled toward the handle 166a, the spring 168 iscompressed, thrusting the cylindrical cutter 162 forward. As a result,the cutter 162 cuts off the unnecessary portions of the walls of thesevered parts of the tubular organ 180, as is illustrated in FIG. 36B.

As described above, both rings 173 and 175 of the staple are oscillatedat an ultrasonic frequency in the stapler 155 and fuse to each other byvirtue of the heat generated by the dynamic friction between them. Thestapler 155 can, therefore, achieve reliable suture of a tubular organ.

FIGS. 37 and 38 show one of jaws 181 of a clip applicator which is aneleventh embodiment of the present invention. The clip applicator has apair of jaws 181 for holding a clip between them. Each jaw 181 has aclip-holding surface which has of a stylus-holding section 182 and aclip-holding groove 183. The stylus-holding section 182 comprises anet-shaped projections made of tungsten carbide.

FIGS. 39A and 39B explain how a clip applicator according to a twelfthembodiment of the invention apply a plurality of clips 188 in order togather and stitch together the tissues on the sides of a wound. As shownin FIG. 39A, the clips 188 loosely connected by a thread 189 are fixedto both sides of the wound in staggered fashion. Then, the thread ispulled, moving the clips 188 on one side of the would toward those onthe other wide thereof as shown in FIG. 39B. As a result, the tissues onthe sides of the wound are gathered and stitched to each other.

A clip applicator 191, which is a thirteenth embodiment of the presentinvention, will be described with reference to FIGS. 40, 41 and 42 andFIGS. 43A, 43B and 43C.

As can be understood from FIG. 40, the clip applicator 191 comprises asheath 192, two handles 193a an 193b both connected to the proximal endof the sheath 192, and a pair of jaws 194a and 194b connected to thedistal end of the sheath 192. The sheath 192 can be inserted into a bodycavity, guided through a tubular instrument such as a trocar. The handle193a is fixed to the sheath 192, and the handle 193b is rotatablycoupled to the middle portion of the fixed handle 193a. The lower jaws194b is fastened to the distal end of the sheath 192, and the upper jaw194a is rotatably coupled to the lower jaw 194b. A connecting rodextends through the sheath 192, connecting the upper jaw 194a to theupper end of the rotatable handle 193b. Hence, when the rotatable handle193b is moved toward and away from the fixed handle 193a, the rod movesthe upper jaw 194a into its open position and into its close position.

As is shown in FIG. 41, the lower jaw 194b has a hole 195 opening in theside opposing the upper jaw 194a. As shown in FIG. 40, a laser 196 and abeam controller are located outside the clip applicator 191. The laser196 is connected to the beam controller. An optical fiber 197 extendsfrom the beam controller to the hole hole 195, passing through thesheath 192.

FIG. 42 shows a clip 198 which the applicator 191 applies. The clip 198is made of resin, having an upper leg 199a and a lower leg 199b whichare connected to each other at a hinge portion 200. The upper leg 199ahas a pin 201 protruding toward the lower leg 199b. The lower leg 199bhas a through hole 202 so positioned as to received the pin 201 when thelegs 199a and 199b abut on each other.

The clip applicator 191 is manipulated as follows, in order to apply theclip 198 to ligate a tubular organ. The clip 198 is held between thejaws 194a and 194b as shown in FIG. 43A, and a tubular organ 203 isplaced between the legs 199a and 199b of the clip 198. Next, as shown inFIG. 43B, the handles 193a and 193b are gripped, moving the handle 193btoward the handle 193a, whereby putting the upper jaw 194a into theclose position. As shown in FIG. 43C, the clip 198 is closed, with itspin 201 inserted into the hole 202. In this condition, a laser beam isapplied from the laser 196 into the hole 195 of the lower jaw 194bthrough the beam controller and the optical fiber 197. The thermalenergy of the beam melts that portion of the pin 201 which is insertedin the hole 202, fusing the same to the lower side of the lower leg199b.

Once the lower end of the pin 201 has been thus fused to the lower sideof the leg 199b, the clip 198 does not release the tubular organ 203.Thus, the clip applicator 191 can ligate tubular organs withreliability.

The clip applicator 191 is of the type designed to apply one clip at atime. Instead, it may be of the type which can apply a plurality ofclips at a time.

A stapler 210 according to a fourteenth embodiment of the invention willbe described, with reference to FIGS. 44, 45, and 46.

As is evident from FIG. 44, the stapler 210 comprises an insertionsection 211, a stapling section 212 attached to the distal end of theinsertion section 211, and an operation section 213 fixed to theproximal end of the insertion section 211.

As FIG. 45 shows, the stapling section 212 comprises a casing 214, acartridge 215, and an anvil 216. The casing 214 is generally atop-opening rectangular box and secured to the distal end of theinsertion section 211. The cartridge 215 is removably contained in thecasing 214. The anvil 216 is hinged at its read end to the rear end ofthe casing 214 and can therefore be rotated to an open position and aclosed position; it is normally in the closed position, covering the top(i.e., staple-holding surface) of the casing 214. A knife-guiding groove217 is formed in the top surface of the casing 214, extending along theaxis of the casing 214 for guiding a knife 219 used for sever bodytissues. Also formed in the top surface of the casing 214 are tworectangular recesses 218 located on the sides of the groove 217, forholding the bases 57 of staples 56. The staple bases 57 are placed ineach recess 218. The staples 56 are identical to those shown in FIG. 12,and will not described here again.

The anvil 216 contains a laser probe 220 and a heat-resistant member221. The laser probe 220 is used to heat and deform deforming the tipsof the pins 59 of each staple 56. As shown in FIG. 46A and 46B, theheat-resistant member 221 is positioned, opposing the tip of the laserprobe 220. The anvil 216 also contains staple covers 58.

Referring to FIG. 44 again, the operation section 213 has a handle 223for opening and closing the anvil 216, and a firing handle 224 forapplying a laser beam to the probe 220. A laser 225 is connected to theoperation section 213.

The stapler 210 is manipulated in the following way. First, the staplingsection 212 is positioned such that the body tissues 222 are placedbetween the cartridge 215 and the anvil 216. Next, the handle 223 isoperated, rotating the anvil 216 to the closed position and, hence,clamping the body tissues 222. The pins 59 of each staple 56 pierce thetissues 222 and slip into the holes 60 of the cover 58 and protrude fromthe cover 58, as is illustrated in FIG. 46A. The firing handle 224 ispulled, applying a laser beam from the laser 225 to the laser probe 220and hence to the tips of pins 59. The pins 59 are heated and fused ontothe upper surface of the cover 58 as is shown in FIG. 46B. As a result,the staples 56 fasten the body tissues 222 together--as steadfastly asin the staplers shown in FIGS. 11 and 19.

A clip applicator 230, which is a fifteenth embodiment of the invention,will be described with reference to FIGS. 47 to 55.

As shown in FIG. 47, the clip applicator 230 comprises an operationsection 231, an insertion tube 232 extending from the distal end of theoperation section 231, and a clip-applying section 233 connected to thedistal end of the tube 232. The tube 232 is to be inserted into a bodycavity, and the clip-applying section 233 is designed to apply two clips235a and 235b to ligate a tubular organ 234 such as a blood vessel andsubsequently sever the organ 234, as is illustrated in FIG. 48.

Both clips 235a and 235b are made of resin which can be absorbed intobody tissues. As shown in FIG. 52, each clip has a sawtoothed portion236 at one end, and a holder portion 237 at the other end. The holderportion 237 is designed to hold the sawtoothed portion 236. The clips235a and 235b are connected by two strips 238 of adhesive tape. As shownin FIG. 49, the clips 235a and 235b are contained in the insertion tube232 and can be pushed to the clip-applying section 233 by means of apair of clip-pushing springs 239 which extend through the insertion tube232. Another pair of springs 240 extend through the tube 232, betweenthe clip-pushing springs 239. When the springs 240 are thrust to theclip-applying section 233, their distal end portions spread sideways bytheir own bias, moving two clips 235a and 235b already pushed into theclip-applying section 233 as is illustrated in FIG. 50. As a result, theclips 235a and 235b are placed at positions where they oppose the distalends of clip-holders 241 located within the insertion tube 232.

The clip holders 241 are connected to an ultrasonic oscillator 242 whichis incorporated in the operation section 231 as shown in FIG. 47, sothat the ultrasonic oscillation generated by the oscillator 242 may betransmitted to the clip holders 241. The ultrasonic oscillator 242 canbe moved back and forth in the operation section 231 when a handle 243(FIG. 47) is operated. More precisely, when the handle 243 is squeezed,the oscillator 242 is pushed forward. As shown in FIG. 55, a knife 245extends through the insertion tube 232 and can slide along the axis ofthe tube 232 for cutting the tubular organ 234 and the strips 238 ofadhesive tape.

In operation, the clips 235a and 235b pushed into the clip-applyingsection 233 are closed by operating the clip holders 241. This done, theultrasonic oscillator 242 is energized, generating ultrasonicoscillation. The clip holders 241 transmits the oscillation to theclosed clips 235a and 235b. By virtue of the ultrasonic oscillation,heat is generated between the sawtoothed portion 236 and holder portion237 of each clip which are in frictional contact. The portions 236 and237 of the clip are thereby fused together. As a result, the clips 235aand 235b would not open, reliably clamping the tubular organ 234.

Since the sawtoothed portion 236 and holder portion 237 of each clip areheated by ultrasonic oscillation, the remaining parts of the clip arenot heated so much as to lose their rigidity.

The legs of the clip hitherto been used to ligate a tubular organ bymechanical means (e.g., latches) needs to have a large contactingsurfaces to ensure reliable ligation of the organ. Inevitably it largeand thick as a whole; it requires a large incision for penetration intoa body cavity and is difficult to handle. By contrast, the clips 235aand 235b are sufficiently small since the legs of each clip are fastenedto each other by ultrasonic oscillator, not by any mechanical means.

A stapler, which is a sixteenth embodiment of the invention, will bedescribed with reference to FIGS. 56, 57, and 58. This stapler isidentical to the stapler 210 shown in FIGS. 44 and 45, except that thelaser probe 220 is replaced by the ultrasonic oscillator 141 and theoscillation-transmitting member 142, both shown in FIG. 32, in order tofasten the staple bases 57 and the staple covers 58 by means ofultrasonic oscillation. Once the base 57 and corresponding cover 58 ofeach staple 56 are fused together by virtue of ultrasonic oscillation asshown in FIG. 58, the staple 56 keeps holding body tissues 222 in steadfast connection.

Another clip applicator, which is a seventeenth embodiment of thepresent invention, will be described with reference to FIGS. 59, 60, and61.

As can be seen from FIG. 59, the clip applicator comprises an operationsection 250 and an insertion section 251 extending from the distal endof the operation section 250. The operation section 250 contains anultrasonic oscillator 252 and a horn 253, and has a handle 254 and agrip 255. An oscillation-transmitting member 256 extends forward fromthe horn 253 through the insertion section 251. The member 256 has anoscillating tip 257. A clip holder 258 is inserted in the distal end ofthe insertion section 251 and can be moved along the axis of the section251 as the handle 254 is operated. The ultrasonic oscillator 252 isconnected to a drive circuit 259, which in turn is connected to a drivesignal generator 260.

FIG. 61 shows a clip 261 which the applicator applies to ligate a bodyorgan. The clip 261 is a molding made of thermoplastic resin. Itconsists of a pair of legs 262a and 262b and a hinge 263 connecting thelegs 262a and 262b at one end. A plurality of tiny projections 264protrude from the opposing sides of the tips of the legs 262a and 262b.The leg 262a is thinner than the leg 262b and can be bent more easily.

As is shown in FIG. 60, the clip holder 258 has an L-shaped anvil 265which opposes the oscillating tip 257 of the oscillation-transmittingmember 256. The clip 261 is held, with the legs 262a and 262b abuttingon the oscillating tip 257 and the anvil 265, respectively. The theoscillation-transmitting member 256 is held in a retreated position by aspring (not shown), and the anvil 265 can be moved backwards byoperating the handle 254.

The clip applicator shown in FIG. 59 is operated in the following way.First, the clip 261 is held between the anvil 265 and the oscillatingtip 257 of the member 256 as is shown in FIG. 60. Then, body tissues tobe fastened together are moved into the gap between the legs 262a and262b of the clip 261, while being observed through an endoscope. Next,the handle 254 is pulled, moving the anvil 265 backwards. The clip 261is thereby closed, clamping the tissues. In this condition, theultrasonic oscillator 252 is driven, generating ultrasonic oscillation.The oscillation-transmitting 256 transmits the oscillation to the clip261. The projections 264 of the leg 262a and those 264 of the leg 262b,which abut in point contact, are oscillated and fused together, wherebythe legs 262a and 262b are permanently connected to each other.

Due to the point contact between the projections of the leg 262a andthose of the leg 262b, heat is generated concentratedly at the tips ofthe projections 264, whereby the projections 264 can be fused within ashort time. Even if the tissues are wet with body fluid such as blood,the projections reliably abut on one another, the legs 262a and 262b canbe fastened together readily and steadfastly.

FIG. 62 shows a clip 267 which is an eighteenth embodiment of thepresent invention. The clip 267 comprises a pair of legs 268a and 268band a hinge 269 connecting the legs 268a and 268b at one end. Allcomponents of the clip 267 are formed integral, made of resin. Thoseportions 270 of the legs 268a and 268b, which extend between the hinge269 and the free ends of the legs 268a and 268b, are made of foamedresin or porous resin. The mutually opposing sides of the tips of thelegs 268a and 268b serve as fusing surfaces 271. A rectangular fuse 272is mounted on the surface 271 of the leg 268a. The leg 268b has arectangular recess 273 formed in that side of its tip which faces awayfrom the fusing surface 271. The recess 273 serves to transmitultrasonic oscillation readily to the leg 268b.

When the clip 267 is held and closed at the distal end of the applicatorshown in FIG. 59 (i.e., the seventeenth embodiment) and then subjectedultrasonic oscillation, the fuse 272 is fused to the fusing surface 271of the legs 268a and 268b, whereby the legs 268a and 268b are deformedand fastened together firmly. The ultrasonic oscillation applied to therecess 273 is not well transmitted to the portions 270 of the clip 267because the portions 270 are less dense than any other portions. Hence,the portions 270 generate far less heat, if any, scarcely affecting thetissues clamped between the legs 268a and 268b with oscillation or heat.Not the entire portions 270, but only the surface regions thereof may bemade of foamed resin or porous resin. Alternatively, a sponge-like resinlayer may be bonded to the inner surface of each leg.

FIG. 63 shows a clip 275 which is a nineteenth embodiment of the presentinvention. The clip 275 comprises a pair of legs 276a and 276b and ahinge 277 coupling the legs 276a and 276b at one end. All components ofthe clip 275 are formed integral, made of thermoplastic resin. The leg276a has a raised portion 278 on the inner surface of its free end,whereas the leg 276b has a recessed portion 279 formed in the innersurface of its free end. The leg 276b has a rectangular recess 280formed in the outer side of its free-end portion. When to be used, theclip 275 is held in the distal end of the applicator shown in FIG. 59(i.e., the seventeenth embodiment), with the oscillating tip 257 of themember 256 abutting on the bottom of the rectangular recess 280. Oncethe clip 275 is closed, clamping tissues between the legs 276a and 276b,the raised portion 278 of the leg 276a fits into the recessed portion278 of the leg 276b. The legs 276a and 276b are thereby prevented fromdisplacing sideways from each other. This helps to shorten the timerequired for fusing the free ends of the legs 276a and 276b together.

FIG. 64 shows a clip 281 which is a twentieth embodiment of thisinvention. Like those shown in FIGS. 61, 62, and 63, the clip 281comprises a pair of legs 282a and 282b and a hinge 283 coupling the legs282a and 282b at one end, and all of its components are formed integraland made of thermoplastic resin. The leg 282a has a projection 284protruding from that part of its inner surface which is close to thehinge 283. To ligate tissues together, the clip 281 is closed, holdingthe tissues between the legs 282a and 282b, with the projection 284abutting on the inner surface of the leg 282b. In this condition,ultrasonic oscillation is applied to the clip 281. The projection 284 isthereby melted and fused to the leg 282b, whereby the legs 282a and 282bare fastened to each other, clamping the tissues steadfastly. As can beunderstood from FIG. 64, the middle portion of the leg 282a is gentlycurved away from the leg 282b.

Since no projections protrude from the free-end portion of the leg 282aor 282b, body tissues can be smoothly guided into the gap between thelegs 282a and 282b; the projection 284, located near the hinge 283, doesnot impede the guiding of the tissues. Further, since the middle portionof the leg 282a is gently curved away from the leg 282b, the tissuesclamped between the legs 282a and 282b do not hinder the fusing of theprojection 284. The clip 281 can be applied to fasten flat tissuestogether, too.

A twenty-first embodiment of the present invention will be described,with reference to FIG. 65, FIGS. 66A, 66B and 66C, and FIG. 67.

FIG. 65 shows a clip 290 used in this embodiment. Like those shown inFIGS. 61, 62, 63, and 64, the clip 290 comprises a pair of legs 291a and291b and a hinge 292 coupling the legs 291a and 291b at one end, and allof its components are formed integral and made of thermoplastic resin.The clip 290 has two styluses 293 and 294 protruding from the innersurface of the leg 191b and located at the middle and the free-endportions of the leg 291b, respectively. The stylus 293 is shorter thanthe stylus 294. The leg 291b has a rectangular recess 295 formed in theouter side of the free-end portion, for efficiently transmittingultrasonic oscillation to the leg 291b.

FIG. 67 shows an ultrasonic clip applicator designed to apply the clip290. As is shown in the figure, the applicator comprises an operationsection 296 and an insertion section 297. The operation section 296comprises a grip 298 and a handle 299 rotatably connected to the grip298. The grip 298 contains an ultrasonic oscillator 300. A push-buttonswitch 303 consisting a push button (i.e., movable contact) and twostationary contacts. One stationary contact is electrically connected tothe oscillator 300, which in turn is connected to a drive circuit 301provided out side the grip 298. The other stationary contact iselectrically connected to an oscillation circuit 302, which is locatedoutside the grip 298 and connected to the drive circuit 301.

The insertion section 297 contains a member 304 for transmittingultrasonic oscillation and a link 305 for opening and closing a jaw 306.The link 305 has its proximal end connected to the handle 299 and itsdistal end coupled to the rear end of the jaw 306. The jaw 306 isrotatably coupled to the distal end of the insertion section 297. Theoscillation-transmitting member 304 has an oscillating tip 307.

The clip applicator is manipulated as follows to apply the clip 290 inthe following way. First, the clip 290 is held between the jaw 306 andthe oscillating tip 307 as is shown in FIG. 67. Then, as shown in FIG.66A, a tubular organ 308 (e.g., a blood vessel) is positioned in the gapbetween the legs 291a and 291b of the clip 290. Thereafter, the handle299 is squeezed, rotating the jaw 306 and subsequently closing the clip290 as shown in FIG. 66B. The tubular organ 308 is thereby clamped andcollapsed between the legs 291a and 291b. Then, the push-button switch303 on the grip 298 is pushed, driving the ultrasonic oscillator 300.The oscillator 300 generates ultrasonic oscillation, which istransmitted to the clip 290 by the oscillation-transmitting member 304.

The styluses 293 and 294, which pierce a layer of fat or the like, ifany, and abut on the inner surface of the leg 291b, are fused at theirtips, fixing the leg 291a to the leg 291b. Hence, the clip 290 isdeformed in its closed state, ligating the tubular organ 308. Bothstyluses 293 and 294 can easily pierce the organ 308 by virtue of theultrasonic oscillation applied to them.

Thus, even if some tissues have not been separated from the tubularorgan 308, the clip 290 can reliably ligate the organ 308. Since thestyluses 293 and 294 bite into the organ 308 as the clip 290 is closedby rotating the jaw 306, that portion of the organ 308 which should beligated is not displaced from the clip 290.

FIG. 68 shows a clip 310 which is a twenty-second embodiment of thepresent invention. The clip 310 comprises a pair of legs 311a and 311band a hinge 312 connecting the legs 311a and 311b at one end. Allcomponents of the clip 310 are formed integral and made of thermoplasticresin. Each leg has a serration 313 on the inner surface of its free-endportion. The serration 313 serves as fusing surface. The clip 310 isapplied in the same way as the clips shown in FIGS. 61 to 65. Theserrations 313 formed on the abutting end portions of the legs 311a and311b can be readily fused together when ultrasonic oscillation isapplied to the clip 310. The legs 311a and 311b can therefore befastened together, creating a sufficient clamping or ligation force.

A twenty-third embodiment of the invention will be described withreference to FIGS. 69 and 70. FIG. 69 shows the distal end portion of aclip applicator according to this embodiment. As FIG. 69 shows, theapplicator has a pair of jaws 317 and 318. The first jaw 317 has aclip-holding groove 319 formed in its inner surface and a rod-shapedheater 320 protruding from the bottom of the clip-holding groove 319. Asis shown in FIG. 70, the heater 320 is held by an heat-insulating member327 which is embedded in the first jaw 317. The second jaw 318 has aclip-holding groove 328 and a clip-holding projection 321 protrudingfrom the bottom of the groove 328.

The jaws 317 and 318 are designed to close a clip 322. The clip 322comprises a pair of legs 323a and 323b and a hinge 323a connecting thelegs 323a and 323b at one end. All components of the clip 310 are formedintegral and made of thermoplastic resin. The leg 323a has a throughhole 324 in its free end portion, whereas the leg 323b has a projection325 protruding from the inner surface of its end portion. The projection325 is so positioned as to fit into the hole 324 of the leg 323a whenthe clip 322 is closed. The leg 323b has a hole 326 in the outer side ofits end portion, for receiving the clip-holding projection 321 of thesecond jaw 318.

To load the clip 322 in the distal end portion of the clip applicator,the leg 323a is placed in the clip-holding groove 319 of the first jaw317, and simultaneously the rod-shaped heater 320 is inserted into thehole 324 of the leg 323a. Further, the leg 323b is placed in theclip-holding groove 328 of the second jaw 318, and the clip-holdingprojection 321 of the second jaw 318 is inserted into the hole 326 ofthe leg 323b. As a result, the clip 322 is held between the jaws 317 and318, in its open position.

The distal end portion of the clip applicator is guided into a bodycavity and moved until the body tissues to be fastened together arecaught in the gap between the legs 323a and 323b. Thereafter, the heater320 is turned on, heating the projection 325 of the leg 232b and fusingthe same to the leg 323a. The legs 323a and 323b are thereby permanentlyfastened to each other, clamping the tissues between them steadfastly.

It is only the projection 325 that the heater 320 heats. Since no otherparts of the clip 322 are heated very little or not heated at all, thetissues are not thermally affected. The rod-shaped heater 320 may bereplaced by a stylus-shaped one, so that the projection 325 may beheated more efficiently.

FIG. 71 shows a clip which is a twenty-fourth embodiment of the presentinvention. This clip is identical to the clip 322 shown in FIG. 69,except that a heat-sensitive material, which changes color as it isheated, is contained in the middle portions 329 of legs 323a and 323b.The clip is applied by the same method as the clip 322 of FIG. 69. Henceit is possible to detect the temperature to which the legs 323a and 323bhave been heated, from the color the middle portions 329 do present.This helps to heat and fuse the projection 325 appropriately.

A clip 330, which is a twenty-fifth embodiment of the invention, will bedescribed with reference to FIGS. 72, 73, 74A, 74B, and 75. The clip 330is of a type which is permanently closed by means of ultrasonicoscillation.

As shown in FIG. 72, the clip 330 comprises a pair of legs 331 and 332and a hinge 333 connecting the legs 331 and 332 at one end. Allcomponents of the clip 330 are formed integral and made of thermoplasticresin. The middle portions of the legs 331 and 332 function astissue-clamping members. The legs 331 and 332 have thin plate-like endportions 334 and 335 which are to be fused together. The middle portionof the leg 331 is comprised of two parallel square bars 336, and that ofthe leg 332 is comprised of one square bar 337. These bars 336 and 337are thicker than the end portions 334 and 335. The bars 336 are spacedapart for a distance slightly longer than the width of the bar 337. Aslong as the clip 330 remain open, the bars 336 and 337 assume suchpositions as shown in FIG. 74A. When the clip 330 is closed, the bar 337will have its lower side substantially covering the space between thethe bar 336, as is illustrated in FIG. 74B. The end portion 334 of theleg 331 has projections 338 on its inner surface. Similarly, the endportion 335 of the leg 332 has a projection 338 on its inner surface.

The clip 330, thus constructed, is applied in the following way. Theclip 330 is held in its open position, at the distal end of a clipapplicator (not shown), which is guided into a body cavity. In the bodycavity the distal end of the applicator is moved until a tubular organ339 the clip 330 is to ligate is placed between the legs 331 and 332.Then, the clip 330 is closed, with the end portions 334 and 335 pressedtogether by the oscillating tips 340 of the applicator as is shown inFIG. 75. In this condition, the tips 340 applies ultrasonic oscillationto the end portions 334 and 335. The projections 338 of the end portion334, which are in frictional contact with the end portion 335, and theprojection 338 of the end portion 335, which is in frictional contactwith the end portion 334, are heated and fused. Also, the end portion334 and 335 are eventually fused together. As a result, the clip 330firmly clamps the tubular organ 339.

Since the end portions 334 and 335 are thinner than the bars 336 and337, the heat can hardly be transmitted to the bars 336 and 337 clampingthe organ 339. Further, since the bars 336 and 337 do not contact oneanother, they have no friction among them and, hence, will generate noheat and will not fuse together. Hence, only the end portions 334 and335 are fused together. Thus, the tubular organ 339 clamped by the barswill not be thermally affected at all.

FIG. 76 shows a clip 330 which is a twenty-sixth embodiment of thepresent invention. The clip 330 comprises a pair of legs 331 and 332 anda hinge 333 coupling the legs 331 and 332. The middle portions of theclip 332 are flat plates, not bars as those of the clip shown in FIG.72. The leg 331 has a step 341 in the inner surface, so that when theclip 330 is closed, the middle portion of the leg 331 does not touch theleg 332 though the plate-like end portions 334 and 335 contact eachother. The clip 330 of FIG. 76 is identical to the clip shown in FIG. 72(i.e., the twenty-fifth embodiment) in function and advantage. Bodytissues or organs clamped by the clip 330 are not thermally affectedonly if the end portions 334 and 335 are thin or only if the middleportions of the legs 331 and 332 do not contact.

FIG. 77 shows a clip applicator 10 according to a twenty-seventhembodiment of this invention, which is a modification of the firstembodiment (FIG. 1). The applicator 10 is characterized in that theelectric heater 19 attached to the first clip-holding member 13 iswrapped by a heat-insulating member 345. The heat-insulating member 345can be made of various materials such as ceramic, gas- or liquid-sealedmaterial, or heat-resistant resin (e.g., fluorine resin). It is only thepin 4 of the clip that contacts the electric heater 19. Therefore, theheat the heater 19 generates is not transmitted to any other componentof the clip, and the heat is applied concentratedly to the pin 4.

Another clip applicator, which is a twenty-eighth embodiment of theinvention, will be described with reference to FIGS. 78 and 79.

As can be understood from FIGS. 78 and 79, the applicator comprises asheath 351, a clip holder 352 extending through the sheath 351 andprotruding from the distal end thereof, and a rod-shapedoscillation-transmitting member 354 extending through the sheath 351 andprotruding there of. The clip holder 352 has an tip which is L-shaped tohold a clip 353. The member 354 is connected at its proximal end to anultrasonic oscillator (not shown) which is housed in the proximal end ofthe applicator. The member 354 can be moved back and forth, fortransmitting ultrasonic oscillation generated by the oscillator to theclip 353 held at the tip of the holder 352. When pushed forward, theoscillation-transmitting member 354 can press the clip 353 firmly ontothe tip of the clip holder 352 and can apply ultrasonic oscillation tothe clip 352.

Two stoppers 335 protrude from the clip holder 352 and theoscillation-transmitting member 354, respectively. The stopper 335 onthe member 354 abuts on the stopper 335 on the clip holder 352, uponmoving toward the tip of the holder 352 for a predetermined distance,preventing any further forward motion of the member 354.

The clip applicator applies the clip 353 in the following way. First,the distal end of the applicator is inserted into a body cavity, withthe clip 353 held at the tip of the clip holder 352. The distal end ofthe applicator is moved in the body cavity, thereby placing a tubularorgan (not shown) such as a blood vessel in the gap between the legs ofthe open clip 353. Then, the oscillation-transmitting member 354 ispushed forward, closing the clip 353, which clamps the tubular organ.The ultrasonic oscillator is driven, generating ultrasonic oscillation.The member 354 transmits the oscillation to the clip 353, whereby thelegs of the clip 353 are fused to each other at their contactingsurfaces, ligating the tubular organ.

When the stopper 355 on the member 354 abuts on the stopper 355 on theclip holder 352, the member 354 can no longer move forward and ceases tocontact the clip 353. Hence, the ultrasonic oscillation is no longerapplied to the clip 353, and the legs of the clip 353 are not fusedfurther. The tubular organ is, therefore, clipped steadfastly.

A clip applicator according to a twenty-ninth embodiment of theinvention will be described, with reference to FIGS. 80A, 80B, 81, and82. The applicator differs from the twenty-eighth embodiment (FIGS. 78and 79) in two respects. First, neither the clip holder 352 nor theoscillation-transmitting member 354 has a stopper. Second, the member354 has a groove 356 cut in its distal-end face, as is illustrated inFIGS. 80A and 80B. The groove 356 serves the purpose of holding the clip353 steadily.

The clip applicator is used in the following way, in order to ligate atubular organ (e.g., a blood vessel). One of the legs of the clip 353 isfitted in the groove 356 cut in the distal-end face of theoscillation-transmitting member 354. This done, the distal end of theapplicator is inserted into a body cavity and moved therein, therebyplacing the tubular organ between the legs of the clip 353. Thereafter,the member 354 is thrust toward the tip of the clip holder 352, therebycollapsing or closing the clip 353. The clip 353 clamps the tubularorgan such as a blood vessel. In this condition, the ultrasonicoscillator is driven, generating ultrasonic oscillation. The member 354transmits and applies the oscillator to the clip 353. As a result, heatis generated at those surfaces of the clip legs which are in frictionalcontact, whereby the legs of the clip 353 fuse to each other. The momentthe member 354 abuts on the tip of the clip holder 352, it can no longerapply the ultrasonic oscillation to the clip 353, because the groove 356is slightly deeper than the thickness of the clip 353 completely closed.Hence, the clip 353 are not fused further. The tubular organ is,therefore, clipped reliably.

A clip applicator according to a thirtieth embodiment of the inventionwill be described, with reference to FIGS. 83 and 84. This applicatordiffers from the twenty-eighth embodiment (FIGS. 78 and 79) in threerespects. First, neither the clip holder 352 nor theoscillation-transmitting member 354 has a stopper. Second, the member354 has a groove 357 cut in its distal-end face, for receiving the clip353 held at the tip of the clip holder 352. Third, the tip of the clipholder 352 has a groove 358 for receiving the clip 353.

A clip applicator, which is a thirty-first embodiment of the invention,will be described with reference to FIG. 85. The clip applicator isidentical to the twenty-eighth embodiment (FIGS. 78 and 79), except thatthe stopper on the clip holder 352 and the stopper on theoscillation-transmitting member 354 are used as switch contacts 361 fordriving a drive circuit 362 which is connected to an ultrasonicoscillator (not shown). The clip applicator is manipulated in the sameway as the clip applicator shown in FIGS. 78 and 79, placing a tubularorgan such as a blood vessel in the gap between the legs of the clip353. Then, the member 354 is moved forward, closing the clip 353 held atthe tip of the clip holder 352. The clip 353 thereby clamps the tubularorgan. Thereafter, the ultrasonic oscillator is turned on, generatingultrasonic oscillation. The member 354 applies the oscillation to theclip 353. As a result, heat is generated at those surfaces of the cliplegs which are in frictional contact, and the legs of the clip 353 fuseto each other. Then, the switch contact 361 on the the member 354 abutson the switch contact 361 on the clip holder 352, whereupon the drivecircuit 362 stops supplying drive signals to the ultrasonic oscillator.Subsequently, the oscillator cease to generate ultrasonic oscillation.Hence, the clip 353 are not fused further. The tubular organ, e.g., ablood vessel, is therefore clipped reliably.

A clip applicator, which is a thirty-second embodiment of the invention,will be described with reference to FIG. 86. This clip applicator is amodification of the thirty-first embodiment (FIG. 85), and is differentin that a timer 364 is used in place of the switch contacts 361. Thetimer 364 is connected to a drive circuit 362 for driving an ultrasonicoscillator (not shown). The time the legs of the clip 353 require tofuse completely to each other, while being oscillated is set in thetimer 364. Hence, upon lapse of this period, or the moment the legs ofthe clip 353 are completely fused together, the timer 364 supplies astop signal to the drive circuit 362. In response to the stop signal thedrive circuit 362 stops supplying drive signals to the ultrasonicoscillator, which ceases to generate ultrasonic oscillation. Hence, thefusion of the legs of the clip 353 automatically is terminated. Thus,the clip 353 can firmly clamp a tubular organ such as a blood vessel.

A clip applicator, which is a thirty-third embodiment of this invention,will be described with reference to FIG. 87. This clip applicator is amodification of the thirty-second embodiment (FIG. 86), and ischaracterized in that a temperature sensor 365 is used in place of thetimer 364. The sensor 365 is connected to a drive circuit 362 fordriving an ultrasonic oscillator (not shown). The temperature sensor 365is embedded in the clip-holding side of the tip of the clip holder 352,so as to detect the temperature of the clip 353 held at the tip. Upondetecting that the temperature of the clip 353 has reached apredetermined value, indicating that the legs of the clip 353 have justfused together, the sensor 365 outputs a signal to the drive circuit362. In response to this signal the circuit 362 stops supplying drivesignals to the ultrasonic oscillator, which ceases to generateultrasonic oscillation. Hence, the legs of the clip 353 will not fuseexcessively.

A clip 370, which is a thirty-fourth embodiment of the presentinvention, will be described with reference to FIGS. 88A and 88B andFIGS. 89A and 89B.

The clip 370 is a one-piece member made of thermoplastic resin. As shownin FIGS. 88A and 88B, the clip 370 comprises a pair of legs 371a 371band a hinge 372 connecting the legs 371a and 371b together. Each legconsists of a tissue-holding portion 373 and a fusing portion 374. Thefusing portion 374 has a fusing surface 375. As can be understood fromFIGS. 89A and 98B, the fusing surfaces 374 of the legs 371a and 371bwill contact when the clip 370 is closed as the legs 371a and 371b arerotated in a plane parallel to their fusing surfaces 374.

The clip 370 is applied in the following way. A tubular organ such as ablood vessel is positioned between the legs 371a and 371b, and the clip370 is closed as shown in FIG. 89A. An clip applicator (not shown) ismanipulated, applying forces to the closed clip 370 in the directions ofarrows as illustrated in FIG. 89B, while the fusing portions 374 arebeing heated by means of a heater or ultrasonic oscillation. As aresult, the portions 374 are fused together at their fusing surfaces375.

The organ clamped between the legs 271a and 271b may have elasticitygreat enough to apply forces to push the clip 270 open and, hence, toapply shearing force at the fusing surfaces 375 of the fusing portions374. Nonetheless, the mutual fusion of the portions 374 is so strongthat the clip 370 remains closed, clamping the tubular organ firmly andsteadily.

FIGS. 90 and 91 shows a clip which is a thirty-fifth embodiment of thisinvention. This clip is also a one-piece clip made of thermoplasticresin. As shown in FIG. 90, the clip comprises a pair of legs 376a 376band a hinge 377 coupling the legs 376a and 376b together. The leg 376bhas a wedge-shaped projection 378 protruding from the inner surface ofits free-end portion. The other leg 376b has a recess 379 formed in theinner surface of its free-end portion. The projection 378 and the recess379 serve as means for preventing the legs 376a and 376b from movingrelative to each other.

When the clip is closed as is illustrated in FIG. 91, the projection 378of the leg 376b is fitted into the recess 379 of the leg 376a. The sidesof the projection 378 contact the sides of the recess 379. These sidesare substantially parallel to the plane in which the legs 376a and 376bare rotated. The organ (not shown) clamped between the legs 276a and276b may have elasticity great enough to apply forces to push the clipopen and, hence, to apply shearing force at the contacting sides of theprojection 378 and the recess 379. Nonetheless, the projection 378remains fitted in the recess 379 since the projection 378, which iswedged-shaped, has tightly fitted into the recess 379 having a crosssection complementary to that of the projection 378.

After the clip has been closed, the distal end portions of the legs 376aand 376b are pinched together by applying forces in the directions ofarrows, as illustrated in FIG. 91, while the free-end portions of thelegs 376a and 376b are being heated, by means of a heater or ultrasonicoscillation, at the contacting sides of the projection 378 and therecess 379. As a result, the free-portions 374 are fused together,clamping a tubular organ (not shown) such as a blood vessel steadfastly.

FIGS. 92 and 93 shows a clip 380 which is a thirty-sixth embodiment ofthis invention. The clip 380 is a one-piece clip made of thermoplasticresin. As shown in FIG. 92, the clip 380 comprises a pair of legs 381a381b and a hinge 382 coupling the legs 381a and 381b together. The leg381b has a fusing tongue 383 extending downwards from its free end. Thetongue 383 contacts the end face of the leg 381a when the clip 380 isclosed, as is illustrated in FIG. 93. The connecting surfaces of thetongue 383 and the leg 381a is perpendicular to the plane in which thelegs 381a and 381b are rotated.

The clip 380 is applied as follows to clamping a tubular organ such as ablood vessel. First, the clip 380 in its open state is moved such thatthe organ is placed in the gap between the legs 381a and 381b. Thisdone, the clip 380 is closed, and the free-end portions of the legs 381aand 381b are heated by means of a heater or ultrasonic oscillation andthereby fused together at the contacting surface of the tongue 383 andthe free end of the leg 381a. The organ (not shown) clamped between thelegs 276a and 276b may have elasticity great enough to apply forces topush the clip 380 open and, hence, to apply shearing force at thecontacting surfaces of the tongue 383 and the free end of the leg 381a.In spite of the shearing force, the tongue 383 remains fused to the endface of the leg is 381a. As a result, the clip 380 keeps clamping thetubular organ between its legs 381a and 381b.

A clip applicator 405, which is a thirty-seventh embodiment of theinvention, will be described with reference to FIGS. 94 to 96.

FIG. 94 shows a clip 401 which the applicator 405 (FIG. 95) is to apply.The clip 401 comprises a pair of legs 403 and a hinge 402 connecting thelegs 403. Each leg 403 has a projection 404 protruding from its outersurface. Either the hinge 402 or the entire clip 401 may be heated to bepermanently deformed to clamp body tissues between the legs 403.

The clip 401 is made of a polymer or copolymer of dioxanone, lactide orglycolide. Of the polymer, 5 to 50% by weight is monomer having arelatively low molecular weight of 10,000 or less. Hence, the polymerhas a thermal-deforming point of 100° C., more preferably 45 to 80° C.

As shown in FIG. 95, the clip applicator 405 comprises an insertionsection 406 which is a thin pipe. A pair of clip-holding members 408 and409 are rotatably connected at one end by a hinge 407, thus constitutinga clip holder. The first clip-holding member 408 is fastened to thedistal end of the insertion section 406. Each clip-holding member has agroove 410 in its inner surface. The grooves 410 of the members 408 and409 are positioned to face each other. The grooves 410 will receive theprojections 404 of the clip 402 when the member 409 is rotated into itsclosed position, with the clip 401 held between it and the member 408.

A pin 411 protrudes sideways from the distal end portion of theclip-holding member 409. A connector 412 is rotatably connected at oneend to the pin 411. The other end of the connector 412 is fastened tothe distal end of an operating rod 413, which extends through theinsertion section 406. The rod 413 protrudes from the proximal end ofthe section 406. Fixed to the proximal end of the insertion section 406is an operating handle 417. The handle 417 comprises a handle 414 fixedto the proximal end of the insertion section 406, a handle 416 rotatablyconnected to the fixed handle 414 by a pin 415. The upper end of thenotable handle 416 is connected to the proximal end of the operating rod413. Hence, when the handle 416 is moved toward and away from the fixedhandle 414, the rod 413 is pulled backward and forward, opening andclosing the clip holder constituted by the members 408 and 409.

The insertion section 406 has a fluid passage 418. The passage 418extends between the distal opening 419 of the insertion section 406 anda connecting tube 420 protruding from the proximal end portion of thesection 406. A syringe 421 is removably coupled to the connecting tube420.

The clip applicator 405 is manipulated as follows to apply the clip 410in order to ligate a tubular organ such as a blood vessel and a bileduct.

First, the rotatable handle 416 is moved, thereby rotating theclip-holding member 409 into the open position as shown in FIG. 96. Theclip 401 is put into the gap between the clip-holding members 408 and409. Once the projections 404 of both clip legs 403 enter the grooves410 of the members 408 and 409, the clip 401 can hardly slip out of thenip between the clip-holding members 408 and 409.

Then, the insertion section 406 is inserted into the body cavity where atubular organ 422 to ligate is located. The section 406 is furthermoved, thereby catching the organ 422 between the legs 403 of the clip401. Next, the rotatable handle 417 is squeezed, pushing the operatingrod 413 forward. The clip-holding member 409 is thereby rotated into theclosed position, closing the clip 401 and, hence, collapsing the tubularorgan 422.

In this condition, the piston of the syringe 421 connected to the fluidpassage 418 is pushed, pumping a heated fluid to the distal opening 419of the insertion section 406 through the fluid passage 418. The heatedfluid is hence applied onto the clip 401. The fluid is hot enough todeform the clip 401 thermally. Heated with the fluid, the clip 401softens such that the legs 403 wraps the tubular organ 422 as is shownin FIG. 97. Thereafter, the piston of the syringe 421 is pushed, thistime, pumping cold water to the distal opening 419 of the insertionsection 406 through the fluid passage 418 and subsequently applying thecold water onto the clip 401. The fluid is hot enough to deform the clip401 thermally. Cooled with the water, the clip 401 hardens and ispermanently deformed, thus clamping the tubular organ 422 steadfastly.

Merely by thermally deformed with the heated fluid, the clip 401 canreliably ligate the tubular organ 422--requiring no mechanical fasteningmeans whatever. Therefore, the clip 401 can be made small and simple. Inaddition, the clip 401 can be softened at a relatively low temperature,hot water and cold water can sell serve as heating medium and coolingmedium, respectively.

A clip applicator 405, which is a thirty-eighth embodiment of theinvention, will be described with reference to FIG. 98. The clipapplicator 405 is identical to the thirty-seventh embodiment (FIG. 95),except in that heater 424 such as a diode or a ceramic heater is set ina recess 423 made in the inner surface of the clip-holding member 405.The heater 424 is electrically connected by to a power supply (notshown) provided outside the applicator 405 by a lead wire 425 whichextends through the insertion section 406 and out of the proximal end ofthe section 406.

After the clip-holding member 409 is rotated into its closed position,thus closing the clip 401 and ultimately collapsing the tubular organ422 held between the members 408 and 408 of the clip 401, an electriccurrent is supplied from the power supply via the lead wire 425 to theheater 424. The heater 424 generates heat, which thermally deforms theclip 401. Then, both legs 403 of the clip 401 are cooled and permanentlydeformed, firmly clamping the organ 422 between them.

The clip heating/cooling means is not limited to those employed in thethirty-seventh embodiment (FIG. 95) and the thirty-eighth embodiment(FIG. 98). Instead, a laser beam or hot air may be utilized asclip-heating medium, and any coolant other than cold water (e.g.,coolant gas) may be used as clip-cooling medium.

A staple 431, which is a thirty-ninth embodiment of this invention will,will be described with reference to FIGS. 99 and 100. As is shown inFIG. 99, the staple 431 (used as a suture) is a strip having two clawedends 432, each extending downwards from one end. The staple 431 has twogrooved portions 433 having a groove made in its upper surface, at a1/3-length distance from the ends, respectively.

The staple 431 is made, as a whole, of polymer or copolymer ofdioxanone, lactide or glycolide. The polymer or copolymer contains 5 to40% by weight of a platicizer, either fatty acid or ester of fatty acid,and thus has a thermal-deforming point of 45 to 80° C. Variouscommercial available plasticizers can be used in the polymer orcopolymer, but preferable for use in the invention are: dibutylsebacate, epoxidated soybean oil, dibutyl stearate, epoxidated saffloweroil, esters of oleic acid, and esters of linoleic acid.

The staple 431 is applied in the following way to stitch body tissuestogether. First, the staple 431 is heated and softened. Then, one clawedend 433 of the staple 431 is forced into the end portion of a tissue434a, piercing the same, as shown in FIG. 100. Further, the staple 431is bent at the first grooved portion 433. The staple 431 is then bent atthe grooved portion 433, and other clawed 433 of the staple 431 is thenforced into the end portion of a tissue 434b, piercing the same. As aresult, the staple 431 is deformed as illustrated in FIG. 100. Finally,the staple 431, thus deformed thermally, is cooled and hardened, firmlystitching the body tissues 434a and 434b to each other.

The staple 431 may be heated, deformed, and hardened by means of eithera special-purpose stapler or by a general-purpose stapler.

Merely by thermally softened, then deformed, and finally cooled andpermanently deformed, the staple 431 can suture body tissues 434a and434b together, both readily and reliably--requiring no mechanicalfastening means whatever. The staple 431 can therefore be made small andsimple. Moreover, the staple 431 can be softened at a relatively lowtemperature, it can be heated and cooled by a comparatively simplemethod.

FIG. 101 shows a clip 435 which is a fortieth embodiment of the presentinvention. The clip 435, which is identical in shape to the clip 401(FIG. 94), is made of polymer or copolymer of dioxanone, lactide orglycolide. The polymer or copolymer contains 5 to 40% by weight of anoily image intensifier such as Urographine (tradename) or Lipodole(trade name), and thereby has a thermal-deforming point of 45 to 80° C.

The clip 435 is applied in the same way as the clip 401 (FIG. 94). Theclip 435 achieves the same advantage as the clip 401. It also attainadditional advantages. First, since the clip 435 is made of polymer orcopolymer containing an image intensifier, its position in an patientcan be determined by means of X-ray photography. Second, as the clip 435is absorbed into a body organ, so is the image intensifier, making itpossible to determine how much the clip 435 has been absorbed into theorgan merely by tracing the image intensifier in an X-ray photograph ofthe clipped organ.

FIG. 102 shows a clip 436 which is a forty-first embodiment of thepresent invention. This clip 426 has the same strength as the clip 435but is smaller and thinner. Resin which can be absorbed into bodytissues is has but a small mechanical strength. A clip or staple made ofsuch resin must inevitably made large and thick to have a sufficientstrength. To be adequately strong, the clip 435 is made of polymer orcopolymer of dioxanone, lactide or glycolide, which contains powders ofone or two ceramics absorbable into body tissues, selected from thegroup consisting of tricalcium phosphate (TCP), hydroxyapatite (HAP),and tetracalcium phosphate--in total amount of 5 to 45% by weight.

Made of polymer or copolymer containing ceramic powders, the clip 436can have sufficient strength though it is small and thin. Since theceramic powder contained in the polymer or copolymer is also absorbableinto body tissues, the clip 436 will be absorbed in its entirety intothe body tissues to which it has been applied.

FIGS. 103A to 113 show the forty-second embodiment.

FIG. 103A shows the entire structure of a clip applicator. Thisapplicator comprises a handle portion 501 as an operating portion, andan elongated (or insertion portion 502 connected to the handle portion501, which is to be inserted into a body cavity. The elongated portion502 has a circular shape whose diameter should preferably be 12 mm orless.

The distal end portion of the elongated portion 502 is, for example,open upward, and is provided with a distal end opening portion 503 whichis substantially V-shaped, viewed from the side thereof (see FIG. 103B).This distal end opening portion 503 constitutes a means for holding theclip 511 as an object to be used.

The elongated portion 502 comprises a tubular member, and a channel 504is formed along the lengthwise direction of the tubular member in thetubular member. The channel 504 is open in the distal end side, andcommunicates with the distal end opening portion 503. In the channel504, a probe 505 as an oscillation transmission member of an ultrasonicoscillation means is provided in the channel 504, so as to be slidablein the lengthwise direction. The probe is inserted in a cylindricalprobe cover 506, except for the distal end portion and the base portionof this probe 505. The base end of the probe 505 is connected to anultrasonic oscillator. The probe 505 is made of a schematicallycylindrical member made of metal such as stainless steel, duralmin, Ti₆Al₁₄ V or the like. A tip portion 507 of a conical shape is formed onthe distal end of the probe 505. An O-ring 508 made of heat curing resinsuch as silicon or Teflon (which is a commercial name) is insertedbetween the distal end of the probe 505 and the probe cover 506. A guidemember 509 is slidably provided between the probe cover 506 and thechannel 504 of the elongated portion 502.

Further, as shown in FIGS. 104A to 106B, a clip container means forcontaining a plurality of clips 511 disposed in line is provided belowthe position where the probe 505 is provided, in the channel 504. Thisclip container means is formed of a clip holder groove 512. A pluralityof clips 511 disposed in line are contained in the clip holder groove512. Normally, the clips are contained, disposed in line in a cartridge520. The clips 511 in the cartridge 520 are fed out through the clipholder groove 512, one after another from the first one at the distalend side. The passage portion in front of the clip holder groove 512reaches the distal end opening portion 503, and is formed to becontinuous to the distal end opening portion 503. The clip holder groove512 functions as a guide passage for guiding the clips 511 to the distalend opening portion 503 from inside the cartridge 520.

As shown in FIG. 105, the clip holder groove 512 is provided with a pushtool 513 for pushing the clips 511 to the distal end opening portion503. The push tool 513 has a pair of push edges 514 positioned below theposition of the probe 505 and arranged in the left and right sidesthereof, above the clip holder groove 512. Each of these left and rightpaired push edges 514 is made of a stopper plate spring of metal platematerial such as stainless or the like, and a clip 511 fed out onto andset in the clip holder groove 512 from the cartridge 520 is clampedbetween the pair of push edges 514. Notches 514a for stopping aprojection 511d of the clip 511 are respectively formed in the distalends of the push edges 514.

The structure of the clip 511 will now be explained with reference toFIGS. 110A and 110B. The clip 511 is shaped in a form like a prismaticrod and is made of organism adaptive resin such as organism absorptiveresin, nylon, or the like. The shape of the clip 511 will bespecifically explained as follows. The clip 511 has a hinge portion 511aincluding a thin portion, and the hinge portion 511a connects a pair oflegs 511b. The notched amount of the upper side of the hinge portion511a is smaller than that of the lower side thereof. Thus, the clip 511is arranged to be easily bent on the upper side, i.e., on the sidefacing the probe 505. Therefore, as shown in FIG. 110B, the notch in theupper side of the clip 511 should preferably be U-shaped, while thenotch in the lower side should preferably be substantially M-shaped withsmoothness to be continuous to the lower surfaces of both distal endportions 511b. One side surface of the notch of the lower side extendsat an angle of 45° or less, e.g., at 30° with respect to the uppersurface of the clip 511, while the other side surface of this lowernotch should preferably extend at 80° or more with respect to the uppersurface of the clip 511. The projection 511d and the side surfaceextending at 80° should preferably be positioned in the distal end side.In this embodiment, the hinge portion 511a of the clip 511 is elongatedin the lengthwise direction and is made of resin of which high polymeris oriented, in order that the bending resistance is improved.Projections 511d are respectively provided on the left and right sidesclose to the hinge portion 511a. These projections 511d are arranged tobe engaged with the notch grooves 514a provided in the distal ends ofthe push edges 514. In addition, a concave portion 511x is provided inthe upper surfaces of one of both leg 511b, while a convex portion 511yto be engaged into the concave portion 511x is provided in the uppersurface of the other of both legs 511b. The concave portion 511x andconvex portion 511y constitute a clip fixing means for fixing the legs511b.

The clip holder groove 512 forms the distal end opening portion 503 anda slanting surface portion 512a starting from the distal end openingportion 503. A projection 516 which collides into the clip 511 isprovided at the distal end of the slanting surface portion 512a. Theslanting surface portion 512a changes the orientation of the clip 511 byits inclination, thus constituting a force conversion means. This forceconversion means converts the feed force applied to the clip 511 into aclosing force. That portion in the area of the distal end of the clipholder groove 512 which forms the slanting surface portion 512a is widerthan the other portion of the clip holder groove 512 so that clips 511can easily pass through. In this case, the angle of the slanting surfaceportion 512a should preferably be 30° to 60° with respect to theelongated portion 502.

A cartridge 520 is attached to a portion in a relatively rear side ofthe clip holder groove 512. A plurality of clips 511 are disposed inline in the longitudinal direction inside the cartridge 520, and theseclips 511 are elastically energized from the back side through a plunger521 by an elastic means such as a coil spring 522 or by another pressuremeans.

A first stopper plate spring 523 provided in an upper position of theclip holder groove 512 is provided at a position in front of the distalend of the cartridge 520, and a second stopper plate spring 524 isprovided at a lower portion of the clip holder groove 512. The platesprings 523 and 524 temporarily stop a clip 511 fed out of the cartridge520, thereby preventing the clip 511 from moving forward. The stoppersprings 523 and 524 are provided with their base portions fixedlypositioned. For example, the base portion of the stopper plate spring523 is fixed to a cover member 520a of the cartridge 520. The baseportion of the second stopper plate spring 524 is fixed to a member ofthe elongated portion 502. Naturally, the base portion of the firststopper plate spring 523 may otherwise be installed on a member of theelongated portion 502, and the base portion of the second stopper platespring 524 may also otherwise be installed on a member of the cartridge520.

The distal end portions of the stopper plate springs 523 and 524 areboth bent toward the center of the clip holder groove 512 and used asstopper nail portions 523a and 524a, respectively, such that the stoppernail portions 523a and 524a are partially projected into the clip holdergroove 512. In addition, the positions of the stopper nail portions 523aand 524a of the stopper plate springs 523 and 524 are shifted in thelongitudinal direction relative to each other with an intervalequivalent to one clip 511 interposed therebetween. The stopper nailportion of the first stopper plate spring 523 presses the distal end ofa clip 511 fed out from the distal end of the cartridge 520, while thestopper nail portion 524a of the second stopper plate spring 524 pressesanother clip 511 to be fed out next, at the distal end of the cartridge520.

As shown in FIG. 105, a flange portion 525 is provided at a middleportion of the member in the base portion of the push tool 513. When thepush tool 513 is moved forward, the flange portion 525 is brought intocontact with the second stopper plate spring 524 positioned in the upperside, thereby pushing upward the stopper plate spring 524 to be releasedfrom the clip holder groove 512.

A means for operating the push tool 513 and the probe 505 is provided onthe handle portion 501. AS shown in FIG. 107 and FIGS. 108A and 108B,the handle portion 501 is provided with a clamp portion 531, anoperation lever 532 which can freely be opened and closed, a slidableultrasonic oscillator 533, a rotation knob 534 for rotating theelongated portion 502, and a cylindrical member 535 for sliding the pushtool 513 and the probe 505. The ultrasonic oscillator 533 is connectedto an ultrasonic drive circuit 536 including an oscillation controlcircuit and a drive power source 537, as shown in FIG. 103A.

The operation lever 532 is pivoted on the base member of the handleportion 501, and is elastically energized in the opening direction by acoil spring 540. This operation lever 532 is connected to the drivemember 535 through a linking mechanism which will be described later.The linking mechanism comprises a first link 541 as a plate-like memberand a second link 542 having a semicircular cross-section. The secondlink 542 is covered on the outer circumference of the drive member 535.A projecting portion to be slidably engaged in a narrow portion 543 asan inner circumferential groove formed in the outer circumference of thedrive member is provided in the inner circumferential portion of thesecond link 542. The drive member 535 and the second link 542 are in arelationship that the member 535 and the link 542 are rotatable,relative to each other, around the lengthwise axis of the drive member535.

A plurality of latches 538 are attached to the front end of the drivemember 535. The latches 538 can be released aside by the elasticity ofthemselves, and a stopper nail 538a having a slanting surface is formedon the distal end of each latch 538. The stopper nail 538a can beengaged with a flange 539a formed inside a transmission member 539connected with the push member 513. The transmission member 539 is madeof a ring-like member having an inner circumferential surface on whichthe flange 539a is formed. Thus, the drive member 535 is connected tothe push member 513 through the transmission member 539, with the use ofthe latches 538.

An elastic member, e.g., a push spring 545 comprising a compression coilspring, is provided between the transmission member 539 and the handleportion 501, and the push spring 545 elastically energizes thetransmission member 539 and the push member 513 toward the distal endside. In addition, a coil spring 546 is indirectly provided between thedrive member 535 and the probe 505. The coil spring 546 elasticallyenergizes the probe 505, using the drive member 535 as a base.

A hole allowing the probe cover 506 and the push tool 513 to slide isprovided at the rear end portion of the elongated portion 502, and thishole is provided with a sealing means 547 made of elastic resin (e.g.,silicon rubber) or other resin (e.g., form styrene). The flow of a gasfrom the elongated portion 502 side into the handle portion 501 isprevented by this sealing means 547 and the O-ring 508 around the probe505. A gas does not leak even if the elongated portion 502 is insertedinto a gas-expanded body cavity, and thus, the gas-expansion pressuredoes not decrease.

Further, as shown in FIG. 109, this embodiment comprises, as its units,a probe unit 548 including a probe 505 and an ultrasonic oscillator 533,a handle is portion 501 including a grip portion 531, an operation lever532, and a drive member 535, as well as an elongated portion 502including a push member 513, a cartridge 520, and a probe cover 506.Further, these units are connected by means of connection structures,such as screws, collet chucks, cam pins, and the like, so that therespective units are detachable from each other.

In this embodiment, the probe unit 548 and the handle portion 501 areattached to each other or detached from each other, in such a manner inwhich a screw portion 549a is provided in the inner circumference of thedistal end of a probe housing 549 fixing the ultrasonic oscillator 533and the probe 505, and the screw portion 549a is screwed on a rear endportion of the cylindrical member 535a integral with the drive member535. In addition, the inside of the probe housing 549 is completelysealed by means of an O-ring or the like.

At the attachment portion between the handle portion 501 and theelongated portion 502, a detachable knob 561 is provided which isrotatable around the lengthwise axis of the elongated portion 502. Tofix the handle portion 501 to the elongated portion 502, a screw portion562 formed in the rear circumference of the detachable knob 561 isscrewed over a screw portion 563 provided in the outer circumference ofthe distal end of the handle portion 501.

In addition, the push member 513 in the elongated portion 502 is fixedto a transmission member 539 by means of screws, and the probe cover 506is fixed to the drive member 535 by means of screws. In place of screws,methods of using cam pins, friction fixing, and collet chucks (notshown) can be used to attach these components to the elongated portion502.

Next, the operation of the clip applicator 513 constructed above will beexplained. As shown in FIG. 113, the elongated portion 502 is insertedthrough a trocar 552 into an abdomen cavity 551 expanded by injectingthereinto carbon dioxide through a stick needle not shown. Thereafter, atubular organ such as a blood vessel or the like to be clipped isarranged in the distal end opening portion 503 of the elongated portion502 of the clip applicator, while observing the inside of the abdomencavity 551 with the use of an endoscope 554 inserted into the abdomencavity 551 through another trocar 553. (See FIG. 112A.)

When the lever 532 is operated so as to rotate in the direction towardthe closing position indicated by a two-dot chain line in FIG. 103, theengagement between the transmission member 539 and the latch 538 isreleased by a cam means not shown, in the handle portion 501. Then, thetransmission member 539 and the push member 513 slide toward the distalend side, due to elastic energization of the push spring 545 (see FIG.108A).

In this state, the projection 511d of the clip 511 waiting in front ofthe cartridge 520 is engaged with the notch groove 514a at the distalend of the push edge 514. The clip 511 is pushed by the push member 513,and forcibly moves forward over the stopper plate spring 524 provided ina front position, along a clip holder groove 512, to a positionimmediately before the slanting surface portion 512a at the distal endthereof (see FIG. 111A).

When the clip 511 further moves forward to bring the front end of theclip 511 in contact with the slanting portion 512a, a force is appliedwhich serves to rotate the clip 511 around the projection 511d as therotation axis, and a reaction force from the clip holder groove 512causes the front and rear legs 511b to bend in the upward direction,around the hinge portion 511a. Then, the rear leg 511b is further bentupward by the surface so as to be at an angle of 80°. When the distalend of the clip 511 thus reaches a collision surface of the projection516, the clip 511 is V-shaped surrounding the distal end opening portion503 (see FIGS. 111B, 111C, and 111D).

Thereafter, when the lever 532 is closed deeply, the probe 505 furthermoves to the distal end side, and collides with the end surface portionof the rear leg 511b of the clip 511, which is V-shaped (FIG. 111D) inthe distal end opening portion 503 of the elongated portion 502, therebypressing the clip 511 until the clip 511 is completely closed (see FIG.111E). In this state, a coil spring 546 exists between the drive member535 and the probe 505, and therefore, the elasticity of the coil spring546 pushes the clip 511 with a constant force.

In the condition where the clip 511 is thus completely closed, theultrasonic oscillator 533 in the handle portion 501 is driven, and theultrasonic oscillation is transferred to the clip 511 through the probe505. The legs 511b of both ends of the clip 511 which are thus incontact with each other are welded with each other by means of heatingdue to ultrasonic oscillation, and are fixed in a closed form, thuscompleting the clipping of the tubular organ interposed between two legs511b.

When the operation lever 532 is completely closed, the latch 538 and thetransmission member 539 are engaged with each other again in the handleportion (see FIG. 108B). When the force closing the lever 532 is thenreleased, the lever 532 naturally comes back to an original stand-bystate in which the lever is opened, since the lever 532 is energized inthe direction in which the lever 532 is opened. The drive member 535 andthe transmission member 539 to be engaged with a latch 538 movebackward. Simultaneously, the push member 513 and the probe 505 movebackward in the elongated portion 502, and recover to the initial stateshown in FIG. 108A.

Next, operation of the continuous ejection mechanism of clips 511 willbe explained. When the clip 511, held by the first stopper plate spring523 at a front position, is moved to the distal end side by the pushmember 513, the second stopper spring 524 positioned immediately beforethe cartridge 520 is caused to move up by the flange portion 525 on theupper surface of the push member 513, and the clip 511 disposed at thefront end in the cartridge 520 is pushed forward to the front of thecartridge 520 by an energizing force applied through the spring 522provided in the rear end side, so as to be in contact with the firststopper spring in the front end side and to keep on moving until thisclip 511 stops at a nail portion 523a of the first stopper spring 523(see FIG. 104B).

When the push member 513 starts moving backward, the second stopperspring 523 in the rear side enters again between the first one of theline of clips in the cartridge 520 and the clip 511 which have been fedbefore in the cartridge 520, thereby preventing the movement ofrespective clips 511. Then, the push member 513 completely moves to therear end side and is brought into an initial state in which the pushmember 513 is engaged with the projection 511d of the clip 511 beforethe cartridge 520.

The above operation is repeated to continuously feed out a plurality ofclips 511, thereby achieving continuous use of the applicator, with theelongated portion 502 inserted in a body cavity. The continuous ejectionmechanism for clips 511 is not limited to the kind described above, butmay be a belt drive type.

In addition, after use, the probe unit 548, handle portion 501, and theelongated portion 502 are disassembled as shown in FIG. 109, and theprobe unit 548 and the handle portion 501 are subjected to cleaning andsterilization, and then, to re-cycle use.

The clip applicator of this embodiment functions not only as the pushmember 513 for pushing the clip 511 but also as the member for closingthe clip 511, and the structure can thus be simplified. In addition, thestructure inside the distal end portion of the elongated portion 502 issimplified, so that the size of the distal end portion can be reduced.When a blood vessel 555 is inserted in the distal end opening portion503 thereby to locate a clip 511 around the blood vessel 555, the clipmoves around behind the blood vessel 555. Therefore, the blood vessel555 as the target can easily be viewed, and treatments can be made withhigher safety and with improved operation ability.

Further, since a latch structure at the distal end of the legs of theclip 511 is not required any more, it is possible to prevent clips 511from hooking up blood vessels when a clip 511 clips a blood vessel, andtherefore, even a thick blood vessel 555 can be easily clipped.

In addition, since ultrasonic welding is used to fix the legs of a clip511 closed, strong and secure clipping is achieved.

Since clips 511 are disposed linearly in the cartridge 520, the diameterof the elongated portion 502 can be reduced.

Since the clips 511 are made of organism absorptive material, debrisdoes not remain in the human body. Further, since a latch or a hook usedfor fixing clips closed is not provided at both end portions of any theclip 511, a blood vessel is easily held and both ends of the legs of theclip 511 are fixed to each other by means of ultrasonic welding, and theclosed condition can be securely maintained, thereby attaining a rigidclipping force.

Since a clip 511 does not requires any latch or hook portions, the sizeof the clip 511 can be reduced. Further, since clips are contained anddisposed linearly in the cartridge, it is possible to provide astructure in which a plurality of clips are arranged within the width ofthe elongated portion 502, together with probes 505 as oscillationtransmission members. Therefore, clips 511 can be used continuously, oneafter another, with the elongated portion 502 inserted in a body cavityduring operation using an endoscope. This results in reductions in theoperation time.

Since the distal end surface of the elongated portion 502 is slantingand since the distal end opening portion 503 is V-shaped, a targetportion is not hidden by the distal end of the elongated portion, thussecuring an excellent view field and improving the operation ability,when a blood vessel is clipped within the distal end opening portion503.

Sealing of the probe housing 549 enables cleaning, disinfection, and EOG(ethylene oxide gas) sterilization, and the simple structure of thehandle portion 501 enables cleaning, sterilization, and recycle usethereof.

A modification of the above embodiment is shown in FIG. 114, whereinengagement holes 511e are provided in place of projections 511d on theside surfaces of the clip 511, while projections 511f to be engaged withthe engagement holes 511e are provided at the distal ends of the pushedges 514. In this case, excessive convex portions are removed from theshape of the clip 511, so that clips 511 slide more easily in thecartridge 520.

Further, the shape of the clip 511 is not limited to a linear one, butmay be bent at an angle of 90°. In this case, clips can be more easilyarranged at the distal end of the elongated portion 502.

FIG. 115 shows a forty-third embodiment. In the clip 511 of thisembodiment, a hook 511g is provided on the upper surface of one of legs511b, while a receive portion 511h to be engaged with the hook 511g isprovided on the upper surface of the other leg 511b. The receive portion511h has a gap, and the hook 511g is prevented from being detached fromthe receive portion 511h after the hook 511g is once engaged with thereceive portion 511h. The height of the legs 511b at both ends fromtheir lower surfaces are substantially equal to each other.

Except for this point, the structure of this embodiment is substantiallythe same as that of the above forty-second embodiment excluding theultrasonic oscillator 533 from the handle portion 501 thereof. The probe505 is not especially limited to a columnar or cylindrical shape, butmay have a plate-like shape. In addition, the material of the probe isnot limited to titanium.

Thus, a clip 511 is moved to the slanting surface portion 512a at thedistal end of the clip holder groove 512 by the push member 513 and isthen made V-shaped. Thereafter, both ends of the legs 511b are pressedby the probe 505. In this state, the hook 511g and the receive portion511h respectively provided on both ends of the clip 511 are engaged witheach other, so that the clip is fixed closed. The other points ofoperation are similar to those of the forty-second embodiment asdescribed above.

According to this embodiment, the handle portion 501 does not require anultrasonic oscillator, thus simplifying the structure. In addition, theprobe 505 can be made of a plate material and the probe cover cantherefore be removed, and the diameter of the elongated portion 502 canbe reduced much more. Since the height of the clip 511 from the lowersurfaces of both end portions is substantially uniform, clips can bearranged in line. In addition, the same effects as achieved in theforty-second embodiment can be obtained.

FIGS. 116A to 118B show a forty-fourth embodiment. The clip 511according to this embodiment is provided with an arm 511i extending fromthe lower surface of the leg 511b positioned in the rear side of thehinge portion 511a. The width of this arm 511i is smaller than that ofthe legs 511b. Further, in order to contain the arm 511i of the clip511, a guide groove 556 for slidably engaging therein the arm 511i isprovided in the center of the clip holder groove 512, such that theguide groove extends to be close to the distal end opening portion 503.Except for this point, this embodiment is similar to the forty-thirdembodiment.

When the distal end of the leg 511b of the clip 511 slides along theslanting surface and the arm 511i provided on the lower surface of thelegs 511b, the arm 511i is pushed out from the distal end of the guideby the force which has made the clip 511 slide. Then, the leg 511b atthe rear end side of the clip 511 rotates around the hinge portion 511aas the center of rotation, so that the clip 511 is V-shaped at thedistal end opening portion 503. Thereafter, the probe 505 pushes the leg511b in the rear side, so that the receive portion 511h is engaged withthe hook 511g, thereby fixing the legs 511b of both ends closed.

According to this embodiment, since an arm portion 511i is provided forthe clip 511, the rear leg 511b of the clip 511 can securely be made tostand up. Except for this point, the operation of this embodiment issimilar to that of the forty-third embodiment.

FIGS. 119A-119C show a modification of the clip 511 of the forty-fourthembodiment. This modification is an example in which a joint portionhaving a rotation shaft 511k is formed at the hinge portion 511a of theclip 511. Except for this point, this embodiment is similar to theforty-fourth embodiment.

According to this modification, since a rotation shaft 511k is provided,the force required for bending the clip 511 is advantageously reduced.

FIGS. 120 to 122 show an applicator according to the forty-fifthembodiment, wherein detailed explanation of the same components as usedin the applicator of the forty-second embodiment will be omitted.

An opening portion 571 is provided at the distal end portion of theelongated portion 570 of the applicator. The opening portion 571 isconstituted by respectively forming substantially U-shaped (or V-shaped)notch grooves in upper and lower wall portions of the sheath end portionof the elongated portion 570. The front side of the opening portion 571is opened. The upper notch portion has the same shape as the lower notchportion, and these portions are symmetrical to each other. An organ 555such as a blood vessel or the like can be transversely inserted from thefront opened end of the opening portion 571 into the notch penetratingportion of this distal end opening portion 571. A clip 572 which clipsthe blood vessel 555 is provided at the opening is portion 571. Thedistal end portion forming this opening portion 571 has a side face inwhich a groove is formed. The upper and lower widths of the distal endportion are narrow, and the clip 572 of the opening portion 571 can beput inside the groove. A slanting surface 571a bent inwardly is formedon each of the left and right distal end edges of this opening portion571.

In the elongated portion 570, a probe 573 having a quadrangularlongitudinal cross-section is provided along the axial direction of theelongated portion 570, in a position behind the distal end openingportion 571, such that the probe 573 is slidable in the longitudinaldirection of the elongated portion 570. The distal end of the probe 573is formed in a convex shape, and the distal end of the probe 573 waits,facing the distal end opening portion 571, as shown in FIG. 120.

The lower portion of the elongated portion 570 projects generally in aconvex shape, except for the distal end portion where the openingportion 571 is formed. In the elongated portion 570, a push member 574made of a long plate-like member is provided along the axial directionof the elongated portion 570, in the projecting side of the probe 573,i.e., in the lower side thereof, such that the push member is slidablein the axial direction of the elongated portion 570. At a portion behindthe opening portion 571, a guide groove 575, which makes the probe 573and push member 574 slide, is formed to be continuous to the openingportion 571 described above. The opening portion 571 and the guidegroove 575 are arranged linearly and coaxially.

A partition plate 576 is provided below the push member 574. A lowerinner space partitioned by the partition plate 576 and projecting belowthe elongated portion 570 forms a clip container portion 577. The clipcontainer portion 577 contains a plurality of clips 572 disposed inline, in a manner in which clips are directly contained therein or clipsarranged in a cartridge of another member are contained therein. Thedistal end of the clip container portion 577 communicates with the guidegroove in the front side of the prove 573 and in the rear side of theopening portion 571 through a clip feed passage 578.

The feed passage 578 has a slanting surface connected to the guidegroove 575 from the clip container portion 577, and a clip 572 containedin the clip container portion 577 is fed into the guide groove 575,while guiding this clip by the slanting surface 578a.

The distal end portion is normally arranged so as to wait, positionedbackward away from the portion where the clip feed passage 578 isconnected with the slide guide groove 575. The distal end portion of thepush member 574 has a forked shape, and a flange portion 574a to bepressed against the rear end of the clip 572 is formed, bent upward, atthe distal end of the forked shape.

The clip 572 described above comprises a pair of legs 572a connectedwith each other through a hinge portion 572b, and is made of such amaterial as used for the clip according to the forty-second embodiment.In a natural state, the pair of legs of the clip 572 spread over due toelasticity of the hinge portion 572b. A concave portion 572c is formedin the rear end portion of the hinge portion 572b. Further, a pluralityof clips 572 are contained and disposed in line in the clip containerportion 577, with their hinge portions 572b oriented to the back side,and with the pair of legs 572a oriented to the front side. In addition,each of the clips is V-shaped in a natural state. Clips 572 disposed inline and contained in the clip container portion 577 are elasticallypressed to the front side by an elasticity means such as a coil springor the like, from the back side through a plunger or the like not shown,like in the forty-second embodiment described above.

The probe 573 and the push member 574 are driven to slide by the samemeans as used in the applicator according to the forty-second embodimentdescribed above. Except for this point, the structure of this embodimentis similar to that of the forty-second embodiment.

Next, the operation of this applicator will be explained. In the clipcontainer portion 577, since the clips 572 are pressed from the backside, the clip 572 at the distal end of the clips is pushed up along theslanting surface 578a of the feed passage 578, and is fed into the frontslide guide groove 575 at the distal end of the probe 573.

Therefore, the elongated portion 570 is introduced, and an organ such asa blood vessel to be clipped is inserted in the notch portion of thedistal end opening portion 571. The organ is thus caused to transverselypass through the distal end opening portion 571.

When the operation lever of the handle portion of the applicator isrotated toward the closed position, the push member 574 pushes the clip572 at the top end of the clip toward the distal end opening portion571. Further, when the operation lever is closed deeply, the probe 573further slides toward the distal end opening portion 571, so that theclip 572 collides into the slanting surface 571a at the distal end edgeof the distal end opening portion 571, and thereafter, the clip 572 isfurther kept pushed.

Therefore, the ends of both of the legs 572a are pushed inwardly alongthe slanting surface 571a, and the legs of the clip 572 are pushed to beclosed. In addition, since the clip 572 is pushed with the left andright ends of a concave portion 572c of its the hinge portion 572b beingengaged with the convex surface of the top end of the probe 573, theclip 572 is closed more securely. Thereafter, ultrasonic oscillation istransmitted to the probe 573, like in the forty-second embodiment asdescribed above, and both of the legs 572a are welded to each other.Both legs are fixed in this closed form, thus completing the clipping ofthe legs.

When the operation lever of the handle portion is opened, the pushmember 574 is pulled back to a position behind the exit port of the feedpassage 578, and the distal end of the probe 573 is pulled more backwardto the initial state again. Then, the next clip 572 is pushed up ontothe guide groove 575, and waits there until a next opportunity of use.Thus, a plurality of clips 572 can be continuously used, thereby leadingto reductions in the operation time.

According to this embodiment, since an opening portion 571 is providedat the end surface of the top end of the elongated portion 570, a bloodvessel can easily be clipped. In addition, clips 572 can be closed witha simple structure.

Note that in this embodiment, clips 572 can be contained in thecartridge with themselves being closed. In this case, the diameter ofthe elongated portion can advantageously be reduced.

Further, a convex and a concave shape may be provided in the innersurfaces of both legs 572a of the clip 572. In this case, both legs canadvantageously be welded to each other, with ease.

Further, a clip made of resin is fixed in a closed form by ultrasonicoscillation welding, so that secure and strong clipping can be achieved.In addition, since a clip can be fixed in a closed form by ultrasonicwelding, conventional hooks and latches need not be provided at endportions of a clip. The size of the clip can be reduced and the shapethereof can be simplified. Since clips are fed in the sliding directionof the oscillation transmission member, continuous closing and fixing ofclips by means of ultrasonic oscillation welding can advantageously beachieved.

The material absorbable into body tissues, which is used in the presentinvention, many be one hitherto used or one having alow-thermal-deforming point. Even if the glass ceramic powder isabsorbed into body tissues at so slow a rate as to remain unabsorbedinto the tissues, it will not affect the body tissues at all.

FIGS. 123A to 129 show a forty-sixth embodiment. As shown in FIGS. 123Aand 123B, a tissue-fixing medical device 601 has an elongated insertionsection 602 arranged to be inserted into the body cavity and anoperation section 603 which is operated at a position relativelyadjacent to the operator The insertion section 602 has, at the leadingend thereof, an applicator 604 and forceps 605. The operation section603 is composed of a forceps operation section 606 and an applicatoroperation section 607.

As shown in FIGS. 124A, 124B and 125, a thread fixing member 610 made ofthermoplastic resin is accommodated in the leading end portion of theinsertion section 602. The applicator 604 for closing and fixing thethread fixing member 610 and forceps 605 for holding a suturing threadand suturing needle are disposed adjacent to the foregoing leading endportion. The forceps 605 consisting of two forceps jaws 608 and 609 arecapable of opening/closing because the forceps jaw 608 is fixed and theforceps jaw 609 is permitted to be rotated.

An accommodation section 612 in the form of recess for accommodating thethread fixing member 610 and a thread fixing means, for example, anultrasonic-wave transmission and pressing member 613 serving as a threadfixing means, are provided for the applicator 604. The accommodationsection 612 accommodates the thread fixing member 610. The thread fixingmember 610 has a structure such that a jaw 611a and a jaw 611b areclosed. Note that the thread fixing means is not limited to theforegoing ultrasonic wave fixing means.

FIGS. 126 to 129 are diagrams showing the process of a suturingoperation by using the tissue-fixing medical device 601. FIG. 126 is adiagram showing a leading end of the insertion section 602 of thetissue-fixing medical device 601 inserted, from outside, into the bodycavity through a treatment opening (not shown) formed in the abdomen anda leading end 614a of a needle holder 614 inserted, from outside, intothe body cavity through another treatment opening (not shown) formed inthe abdomen.

Initially, the leading end of a thread and needle 616, which has beenheld at the leading end 614a of the needle holder 614 on the outside ofthe body, is allowed to penetrate an end of an incised portion 615 ofthe organization so as to be discharged from the surface of another endof the incised portion 615. The leading end of the thread and needle 616projecting over the surface is, as shown in FIG. 127, held and pulled bythe forceps jaws 608 and 609 of the forceps 605 by operating the forcepsoperation section 606.

Then, the thread and needle 616 are shifted to the leading end 614a ofthe needle holder 614 to continuously suturing the required portion ofthe organization When the suturing operation is completed, the threadand needle 616 are held by the leading end 614a of the needle holder614, as shown in FIG. 128. While applying a tension to the threadportion of the thread and needle 616, the thread portion of the threadand needle 616 is disposed between jaws 611a and 611b of the threadfixing member 610 accommodated in the applicator 604.

Then, the applicator operation section 607 is operated, and then theultrasonic-wave transmission and pressing member 613 is moved forwardsso that the jaws 611a and 611b of the thread fixing member 610 areclosed. When ultrasonic vibrations are transmitted to theultrasonic-wave transmission and pressing member 613, the ultrasonicvibrations are transmitted to the jaw 611a so that the jaws 611a and611b are welded, as shown in FIG. 129. At this time, also the threadportion of the thread and needle 616 is welded. As a result, since thejaws 611a and 611b cannot be opened again, the thread fixing operationis completed.

Since this embodiment has the above-mentioned structure such that theapplicator 604 having the ultrasonic-wave transmission and pressingmember 613, serving as the thread fixing means, and the forceps 605 aredisposed so as to be simultaneously inserted into the body cavity, thenecessity to remove the forceps 605 to the outside of the body and toinsert the applicator 604 for fixing the thread into the body cavitywhen the suturing operation is completed can be eliminated to completethe thread fixing operation with one tissue-fixing medical device 601.Therefore, time required to complete the suturing operation can beshortened. Since time required to complete the operation including thesuturing operation can be shortened, the load, which must be borne by apatient, can be reduced. Moreover, the operator is able to easilyoperate the tissue-fixing medical device 601 so that the suturingoperation is easily be completed. Since the ultrasonic welding method isemployed to fix the thread, the sutured portion can be strengthened. Asa result, the thread fixing operation can be performed reliably.

Although this embodiment has the structure such that the sheath for theapplicator 604 and that for the forceps 605 are formed completelyintegrally, a modification as shown in FIG. 130A may be employed inwhich a sheath 604a for the applicator 604 and a sheath 605a for theforceps 605 may be disposed adjacently while being allowed to runparallel to each other. Thus, the sheath 604a and the sheath 605a areconnected to each other by connecting members 680.

Also the accommodation section 612 in the form of the recess foraccommodating the thread fixing member 610 of the applicator 604 may bestructured as is employed in a modification shown in FIG. 130B such thata separation preventive groove 612a, arranged to be engaged to the jaw611a of the thread fixing member 610 to prevent separation of the threadfixing member 610, is formed at the end portion of the opening portionof the accommodation section 612. In this case, the thread fixing member610 can reliably be accommodated.

FIG. 131 shows a forty-seventh embodiment having the same structure asthat of the forty-sixth embodiment except the applicator 604. Anapplicator 622 according to this embodiment has a cartridge 623 whichaccommodates a plurality of thread fixing members 610 disposed in thesame direction. Moreover, the cartridge 623 includes a supply means 625,such as a slide bar having a hooking claw, for supplying the threadfixing member 610 to the accommodation section 624. An ultrasonictransmission and pressing member 626 for closing and fixing the threadfixing member 610 is disposed on the surface on which the cartridge 623is disposed.

The operation of this embodiment will now be described. Similarly to theforty-sixth embodiment, the thread portion of the thread and needle 616is disposed on the inside of the thread fixing member 610 when thesuturing operation is completed. Then, the thread fixing member 610 ispushed by the ultrasonic transmission and pressing member 626. In theforegoing state, ultrasonic waves are transmitted so that the jaws 611aand 611b of the thread fixing member 610 are welded and thus the threadis fixed. Then, the thread fixing member 610 is discharged after thethread fixing operation has been completed, then the thread fixingmember 610 accommodated in the cartridge 623 is introduced into theaccommodation section 624 by the supply means 625. Thus, the threadfixing operation can be performed successively.

As a result of this embodiment, a successive suturing operation using aplurality of threads and needles 616 can be performed such thatinsertion of the needle holder 614 holding the thread and needle 616enables a next suturing operation to be performed. Since a necessity ofloading the thread fixing member 610 into the applicator 604 on theoutside of the body can be eliminated to suture the required portion ofthe organization, time required to complete the suturing operation canbe shortened. Since time required to complete the operation includingthe suturing operation can be shortened, the load, which must be borneby a patient, can be reduced. Moreover, the operator is able to easilyoperate the tissue-fixing medical device 601 so that the suturingoperation is easily be completed. Since the ultrasonic welding method isemployed to fix the thread, the sutured portion can be strengthened. Asa result, the thread fixing operation can be performed reliably.

FIGS. 132 and 133 are diagrams showing a forty-eighth embodiment havingthe same structure as that of the forty-sixth embodiment except theapplicator 604. An applicator 629 according to this embodiment ispermitted to move in the longitudinal direction along an axis runningparallel to the major axis of the insertion section 602 to a fartherposition (see FIG. 133) over the forceps 605 from a position (see FIG.132) in the insertion section 602 disposed more adjacent to the operatorthan the forceps 605. Moreover, the forceps 605 cannot move in thelongitudinal direction in this embodiment.

The operation of this embodiment will now be described. Since theapplicator 629 can be accommodated in the insertion section 602 when thesuturing operation is performed, the suturing operation is notinterrupted by the applicator 629. Since the applicator 629 is able tomove more forward than the forceps 605 when the thread is fixed, thethread can be fixed without interference with the forceps 605.

Since this embodiment enables the suturing operation and the threadfixing operation to smoothly be performed, time required to complete thesuturing operation can be shortened. Since time required to complete theoperation including the suturing operation can be shortened, the load,which must be borne by a patient, can be reduced. Moreover, the operatoris able to easily operate the tissue-fixing medical device 601 so thatthe suturing operation is easily be completed.

FIGS. 134 and 135 are diagrams showing a modification of thisembodiment. Forceps 630 according to this embodiment are able to, in adirection running parallel to the major axis of the insertion section602, move longitudinally from a farther position (see FIG. 134) than theapplicator 604 to a position (see FIG. 135) in the insertion section 602disposed more adjacent to the operator than the applicator 604.Moreover, the applicator 604 cannot move longitudinally. Since thesuturing operation is, in this embodiment, performed after the forceps630 have been moved forwards, the forceps 630 do not interfere with theapplicator 604 during the suturing operation. Since the forceps 630 canbe moved rearwards when the thread is fixed, the thread fixing operationcan be performed without the interference with the forceps 630. Thus,effects similar to those obtainable from the forty-eighth embodiment canbe obtained.

FIGS. 136 to 138B are diagrams showing a forty-ninth embodiment.Reference numeral 631 represents a medical suturing device according tothis embodiment. The medical fixing device 631 has an operation sectionbody 631a provided with an ultrasonic oscillation section 633 to whichan ultrasonic transmission and pressing member 632 is attached. A handle634 is attached to the ultrasonic oscillation section 633. A sheath 635and a sheath 636 each of which is provided to serve as an outer pipe forthe ultrasonic transmission and pressing member 632 are slidablyattached to the handle 634 in the axial direction of the sheath 636 bythe spring force of a spring 637. Moreover, the handle 634 is permittedto move along a slide groove 639 formed in the case 638.

The case 638 disposed at an end of the insertion section side of theslide groove 639 is provided with a latch 640 structured to be engagedto an engagement section 634a of the handle 634. A spring 641,structured to be abutted against the sheath 636, is disposed in theinsertion section side of the case 638.

Moreover, forceps 643 are disposed at the leading end of an insertionsection 642 of the medical fixing device 631. In addition, an applicator644 disposed at the leading end of the sheath 635 is provided for theleading end of the insertion section 642. The applicator 644 has anaccommodation section 645 on which a thread fixing member 610,structured similarly to that according to the forty-sixth embodiment, ismounted.

The operation of this embodiment will now be described. When the handle634 is moved forwards along the slide groove 639, the ultrasonicoscillation section 633, the ultrasonic transmission and pressing member632, the sheath 635, the sheath 636 and the spring 637 move forwards, asshown in FIG. 137. Thus, the applicator 644 at the leading end of theinsertion section 642 is moved forwards.

When the handle 634 is furthermore moved forwards, the spring 637 iscontracted. Thus, the ultrasonic oscillation section 633 and theultrasonic transmission and pressing member 632 are moved forwards withrespect to the sheath 635 and the sheath 636. At this time, the leadingend of the ultrasonic transmission and pressing member 632 presses thethread fixing member 610 so that the thread fixing member 610 is broughtto a state where it is closed, as shown in FIG. 138A. At this time, thespring 637 is contracted by a degree corresponding to the distance forwhich the thread fixing member 610 has been moved so as to be closed.

Further movement of the handle 634 in the forward direction causes thesheath 636 to be brought into contact with the spring 641. Thus, thespring 641 is contracted so that the engagement section 634a is engagedto the latch 640. Since compressive force has been applied to the threadfixing member 610 at this time as shown in FIG. 138B, the amount ofcontraction realized attributable to the contraction of the spring 641can be absorbed because the spring 637 is contracted. When ultrasonicwaves are emitted from the ultrasonic oscillation section 633, thesuturing thread (not shown) accommodated in the thread fixing member 610and the jaws 611a and 611b of the thread fixing member 610 are welded toone another. That is, the ultrasonic transmission and pressing member632 keeps contact with the thread fixing member 610 by engagementbetween the engagement section 634a and the latch 640, until the jaws611a and 611b are welded to one another by ultrasonic waves. When thelatch 640 has been released after the welding operation has beencompleted, the thread fixing member 610 is separated from theaccommodation section 645. Thus, the thread fixing operation iscompleted and the suturing operation is ended.

Since this embodiment has the structure such that the accommodatedapplicator 644 is moved more forwards than the forceps 643 when thethread fixing operation is performed, the thread fixing operation can beperformed without interference with the forceps 643. Since thecompressive force is given from the spring to the thread fixing member610, engagement to the latch 640 causes predetermined compressive forceto be given. Thus, ultrasonic waves can efficiently be transmitted tothe thread fixing member 610. As a result, the thread fixing strengthcan be enlarged and, therefore, the thread can be fixed more reliably.

Since the foregoing operation can be performed by only the handle 634,the apparatus can easily be operated. Since the thread fixing operationcan be completed in a short time, loads, which must be borne by thepatient and the operator, can be reduced. A structure as shown in FIGS.138A and 138B may be employed in which the forceps 643 and the operationsection body 631a are not disposed on one straight line but theultrasonic oscillation section 633, the ultrasonic transmission andpressing member 632 and the applicator 644, including the thread fixingmember 610, are disposed on the same straight line. In this case,ultrasonic waves can furthermore efficiently be transmitted. Thus, thethread can be fixed more reliably.

The applicator 622 having the cartridge 623 for accommodating aplurality of thread fixing members 610 according to the forty-seventhembodiment may be employed in place of the applicator 644. In this case,the apparatus can be operated easily and the thread fixing operation canbe completed in a short time so that the loads for the patient and theoperator can be reduced.

FIGS. 139 and 140 are diagrams showing a fiftieth embodiment in whichthe structure of the medical fixing device 631 has basically the samestructure as that according to the forty-ninth embodiment. Therefore,the same reference numerals are given to the same elements, and the sameelements are omitted from description. The medical fixing device 631according to this embodiment has a forceps unit section 646, athread-fixing applicator unit section 647 and a shell section 648. Theforceps unit section 646 is detachably attached to the shell section 648by a fixing screw 649 provided for the base portion of the forceps unitsection 646 and serving as an assembling member.

Therefore, when the fixing screw 649 is loosened or fastened, theforceps unit section 646, the thread-fixing applicator unit section 647and the shell section 648 can be decomposed or assembled, as shown inFIG. 140. Thus, the forceps unit section 646 and the thread-fixingapplicator unit section 647 can solely and independently be used.

As a result of the structure according to this embodiment, each of theforceps unit section 646 and the thread-fixing applicator unit section647 can be used solely without a necessity of individually purchasingthe same, if necessary. Since the forceps unit section 646 and thethread-fixing applicator unit section 647 may be combined with eachother to perform a required operation, the medical expenses of ahospital or the like can be reduced. Since the foregoing elements can bedecomposed when they are washed, the washing operation can be performedeasily and satisfactorily

FIGS. 141A to 141D are diagrams showing a fifty-first embodiment of thepresent invention and are front views of the medical fixing device 631.When the fixing screw 649 serving as the assembling means according tothe fiftieth embodiment is loosened, the handle 634 can be rotated tothe leftward position 650b or a rightward position 650c relative to theaxis of the ultrasonic transmission and pressing member 632. Moreover,the thread-fixing applicator unit section 647 can be rotatedindependently from the handle 634 to be moved to an inclined position650d.

According to this embodiment, the handle 634 can be rotated to permitthe operator to use the required hand to operate the apparatusregardless of the size of the hand of the operator. Thus, the apparatusaccording to this embodiment can easily be operated. Since thethread-fixing applicator unit section 647 can be rotated, an optimumangle, at which the suturing thread can easily be fixed, can beselected.

FIG. 142A is a diagram showing the operation section 603 of thetissue-fixing medical device 601 according to a fifty-second embodiment.First and second handles 651 and 652 are rotatively engaged to theoperation section 603. A first link 653 rotatively attached to the firsthandle 651 and a second link 654 rotatively attached to the secondhandle 652 are mutually rotatively attached.

An end of a leaf spring 655 is secured to an end portion of the secondhandle 652, while another end of the same is slidably, elastically andforcibly brought into contact with the inner surface of the first handle651. Moreover, a handle lock 656 is detachably disposed in therotational attachment portions of the first and second handles 651 and652. Thus, the first and second handles 651 and 652 can be locked.

Therefore, when the first and second handles 651 and 652 are squeezed,the jaws of the forceps 605 are closed. When the squeezing force isreduced, the first and second handles 651 and 652 are opened by thespring force of the leaf spring 655 so that the jaws of the forceps 605are opened. After the operation of the first and second handles 651 and652 has been completed and then the handle lock 656 has been brought toa space between the first handle 651 and the second handle 652, thefirst and second handles 651 and 652 and the jaws of the forceps 605cannot be opened.

As a result of the structure according to this embodiment, introductionof the handle lock 656 into the space between the first handle 651 andthe second handle 652 after the operation of the operation section 603has been completed causes the first and second handles 651 and 652 notto be opened. Also the jaws of the of the forceps 605 cannot be opened.Therefore, the thread fixing operation is not interrupted and thus thethread fixing operation can efficiently be performed.

FIG. 142B is a diagram showing a fifty-third embodiment and illustratinga connection and attaching portion between the forceps 605 and a secondlink 654 and forceps 657 having different forceps structure from that ofthe forceps 605. A forceps attaching section 659 is disposed in the baseportion of a drive shaft 658 of the forceps 605. The forceps attachingsection 659 is structured to be detachable with respect to a forcepsreceiver 660 provided for the second link 654.

The drive shaft 658 for connecting the forceps attaching section 659 andthe leading end of the forceps 605 to be held to each other is made of asuper-elastic material. Thus, the forceps 605 can be inserted/removedthrough a curved section 662 of a sheath 661, as shown in FIG. 142A.Therefore, also the forceps 657 having the leading end holding portion,the shape of which is different from that of the forceps 605, areprovided with a drive shaft 658 made of the super-elastic material.Thus, the forceps 657 can be inserted into the sheath 661 so as to beattached to the forceps receiver 660.

Therefore, the forceps 605 can be removed from the leading end of theinsertion section thereof after the forceps attaching section 659 hasbeen removed from the forceps receiver 660. Moreover, the forceps 657having a leading end having a different shape can be inserted into thesheath 661 from the leading end of the insertion section thereof, andthen it can be further inserted toward the operation section from thecurved section 662 of the sheath 661 so as to be attached to the forcepsreceiver 660.

Thus, this embodiment enables the operation for opening/closing theforceps 605 and 657 to be performed smoothly even if the sheath 661 hasa curved shape. Since the forceps 605 or 657 may arbitrarily be selectedto be mounted, a required operation can easily be performed. Since theforceps 605 or the forceps 657 can be removed from the sheath 661, theforceps can easily be washed with a satisfactory result.

FIGS. 143A to 147B are diagrams showing a fifty-fourth embodiment. Asshown in FIGS. 143A to 143C, the surgical operation fixing apparatusaccording to this embodiment is composed of an operation section 701 andan elongation section 702 connected to the operation section 701.

As shown in FIGS. 144A to 147B, the elongation section 702 is composedof a sheath 703, a clip holder 704, a holder opening/closing means 705,a plurality of fixing clips 706, a clip cartridge 707 serving as a clipaccommodating portion, a clip supply means 708, a pusher (bar) 709 andan ultrasonic probe (for example, plate shape) 710.

It is preferable that the diameter of the sheath 703 be not larger than12 mm. The sheath 703 has a circular cross sectional shape. The sheath703 has, in the inner central portion thereof, the ultrasonic probe 710which is disposed detachably. The clip cartridge 707 is disposed oneither side (on the upper side in the case shown in FIG. 144A) withrespect to the ultrasonic probe 710. On another side of the same (on thelower side in the case shown in FIG. 144A), there is disposed the holderopening/closing means 705.

A partition member 711 made of metal or synthetic resin is disposed inthe sheath 703 in order to divide the inner portion into a portion fordisposing the clip cartridge 707 and a portion for disposing the holderopening/closing means 705. The leading end of the partition member 711is allowed to slightly project over the opening formed at the leadingend of the sheath 703. A support-point pin 712 is secured between a sidewall at the leading end of the sheath 703 disposed in front of theholder opening/closing means 705 and the partition member 711, thesupport-point pin 712 being disposed perpendicular to the axialdirection of the sheath 703. An intermediate portion between an upperholder 704a and a lower holder 704b forming the clip holder 704 isrotatively received by the support-point pin 712.

The upper holder 704a and the lower holder 704b are bent sidewards(upwards in the case shown in FIG. 144A) from positions adjacent to thesupported portions. The leading ends of the upper holder 704a and thelower holder 704b are located in front of the leading end of theultrasonic probe 710. A U-shape opening spring 713 is disposed to holdthe support-point pin 712, the opening spring 713 being disposedadjacent to the support portions of the upper holder 704a and the lowerholder 704b. Two leg portions 713a of the opening spring 713 are bentperpendicularly so as to be secured to the inside portion adjacent tothe support portions of the upper and lower holders 704a and 704b sothat the upper and lower holders 704a and 704b are urged in a directionin which they are opened. Moreover, a U-groove 714 for holding thefixing clips 706 and guiding the movement of the same is formed in eachof the opposite surfaces of the upper and lower holders 704a and 704b. Astopper 715 in the form of a projection for the clips 706 is formed atthe leading end of the U-groove 714, that is, at the leading end of eachof the upper and lower holders 704a and 704b.

A pin 716 is allowed to project over the base portion of each of theupper and lower holders 704a and 704b. An end of a link 717 isrotatively connected to each of the pins 716. Another end of each of thelinks 717 is connected to a connection pin 719 of one slider 719 servingas the holder opening/closing means 705. Thus, a link mechanism 720 isformed. When the slider 719 is operated to move forwards, the baseportions of the upper and lower holders 704a and 704b are expanded sothat the upper and lower holders 704a and 704b are rotated relative tothe support-point pin 712. As a result, the leading ends of the upperand lower holders 704a and 704b are closed against the spring force ofthe opening spring 713.

The slider 718 is supported in a slider guide groove 721 formed in thepartition member 711 in such a manner that the slider 719 is able tomove forwards and rearwards. The pusher 709 is arranged to abut againstthe rear end of the slider 719 through a pusher spring 722 accommodatedin the slider guide groove 721. The pusher 709 is supported by thepusher guide groove 723 formed in the partition member 711 in such amanner that the pusher 709 is able to move forwards and rearwards. Whenthe pusher 709 is moved forwards, forward pressure is applied to theslider 718 through the pusher spring 722.

As shown in FIG. 146, the slider guide groove 721 has a width slightlysmaller than that of the pusher guide groove 723. A stepped section 724is formed at the rear end of the slider guide groove 721. The steppedsection 724 is formed to restrict the stroke of the pusher 709 in theforward direction. That is, the elastic force of the pusher spring 722causes the upper and lower holders 704a and 704b to be closed withpredetermined force.

A connection member 725 projecting upwards is secured to a positionadjacent to the base portion of the pusher 709. Moreover, the baseportion of the pusher 709 is, as shown in FIG. 144A, connected to a pipebar connection section 728 formed in the leading end of the pusher pipe727. The pipe bar connection section 728 is formed into an annular shapesecured to the leading end of the pusher pipe 727, the pipe barconnection section 728 having an insertion hole 729, through which theultrasonic probe 710 is inserted. Moreover, the pipe bar connectionsection 728 has a tapered section 730 for guiding insertion of theultrasonic probe 710, the tapered section 730 being formed on thesurface opposite to the operation section 701. A cut portion 731 isformed in the inner surface of the insertion hole 729 of the pipe barconnection section 728, the cut portion 731 being engaged and connectedto an engaging section 732 formed in the base portion of the pusher 709.

The fixing clips 706, the clip cartridge 707 and the clip supply means708 will now be described. The fixing clip 706 is made of resinmanufactured by blending polyactic acid and polyglycolic acid andpermitted to be absorbed by the organization or thermoplastic resin,such as nylon, which is adaptable to the organization. The fixing clips706 having V-shape has two leg portions 706a, two leg portions 706a, 706being connected to each other by a hinge 706b.

A plurality of fixing clips 706 are accommodated in the clip cartridge707 to form a line facing the leading end of the sheath 703 in such amanner that the two leg portions 706a are overlapped. The clip cartridge707 has side rails 733 each having a shallow U-shape cross sectionalshape, the side rails 733 being opened toward the side portion (upperportion in the case shown in FIG. 144A) of the sheath 703. The bottomsurface of the side rail 733 is received and secured by a wide U-groove734 formed in the partition member 711. The bottom portion of the wideU-groove 734 of the partition member 711 has a narrow U-groove 735 intowhich the leading end of the ultrasonic probe 710 is inserted.

A movable plate 736, capable of moving forwards and rearwards, isaccommodated in the inner bottom portion of the side rails 733. A fixedplate 737 serving as a cover for closing the opening of the side rails733 is disposed to be opposite to the movable plate 736. The fixed plate737 is held and secured to the side rails 733 by a holding member 738.The fixing clips 706 is accommodated between the movable plate 736 andthe fixed plate 737.

A plurality of tag shape blades 736a outwards, diagonally and forwardsproject over the movable plate 736 to correspond to the intervals of thefixing clips 706 accommodated in the clip cartridge 707. That is, theblades 736a are integrally formed to project over the movable plate 736by cutting and raising the movable plate 736 to have elasticity so as tobe brought into contact with the rear portion of the hinge 706b of thefixing clips 706. Also tag shape blades 737a outwards, diagonally andforwards project over the fixed plate 737 to correspond to the intervalsof the fixing clips 706 accommodated in the clip cartridge 707. That is,also the blades 737a are integrally formed to project over the fixedplate 737 by cutting and raising the fixed plate 737 to have elasticityso as to be brought into contact with the rear portion of the hinge 706bof the fixing clips 706.

The side rails 733 forming the clip cartridge 707 project over thesheath 703 to be located in the side portion of the clip holder 704 insuch a manner that the leading end of the ultrasonic probe 710 isdisposed between the side rails 733. An opening 739 having a widthpermitting the fixing clips 706 to pass through is formed in the siderail 733 in the portion projecting over the leading end of the sheath703. Moreover, a mounting spring 740 which is a leaf spring having abase portion secured to the fixed plate 737 is disposed in a portionopposite to the opening 739 so that the clip 706 supplied from theleading end of the clip cartridge 707 is loaded into the clip holder 704through the opening 739.

As shown in FIG. 145, the base portion of the movable plate 736 extendsrearwards. An elongated section 741 has an elongated hole 742 formed inthe longitudinal direction. The leading end of the connection member 725bent to bypass the insertion section of the ultrasonic probe 710 isinserted into the elongated hole 742. The elongated hole 742 is designedto have a length capable of absorbing the difference between the strokefor the fixing clips 706 to be moved to the clip holder 704 attributableto the forward movement of the ultrasonic probe 710 and the stroke forthe fixing clips 706 in the clip cartridge 707 to be supplied.

A clip supply means 708 is formed which forwards supplies the fixingclip 706 in the clip cartridge 707 when the movable plate 736 is pushedforwards attributable to the forward sliding movement of the pusher 709.That is, when the fixing clip 706 is closed by the clip holder 704, thefrontmost clip 706 in the clip cartridge 707 can be supplied forwards.Since the movable plate 736 has been moved forwards at this time, theopening 739 is closed by the leading end of the movable plate 736.Therefore, the supplied clip 706 is held while being pressed against themovable plate 736 by the loading spring 740 so that another fixing clip706 is not mounted on the clip holder 704.

The operation section 701 and the ultrasonic probe 710 will now bedescribed. The operation section 701 is composed of a handle 743, alever 744, an ultrasonic oscillator 745, an oscillator holder 746, amovement body 747 serving as an oscillator moving means, an elongatedsection connection means 748 and a pusher moving means 749.

The handle 743 projects sidewards with respect to the axial direction ofthe elongation section 702 so as to be held by the hand of the operator.An intermediate portion of the lever 744 is rotatively supported by thehandle 743 by a rotative support shaft 744a. Moreover, the movement body747 is supported by the handle 743 in such a manner that the movementbody 747 is able to move longitudinally. Pins 750 project over the sidesurfaces of the movement body 747. An engaging hole 751 formed in theend portion of the lever 744 is engaged to the pin 750 so that themovement body 747 is moved longitudinally when the lever 744 isoperated.

The oscillator holder 746 is disposed at the rear end of the ultrasonicoscillator 745. The oscillator holder 746 and the movement body 747 areconnected to each other by a spring 752 so that movement of the movementbody 747 is transmitted to the oscillator holder 746 through the spring752. Moreover, a projection member 753 projecting forwards over thehandle 743 is provided for the movement body 747. A pressing member 754upwardly projecting for pressing the base portion of the pusher pipe 727is integrally formed with the leading end of the projection member 753.That is, the structure is designed in such a manner that the spring 752makes the force given to the ultrasonic probe 710 and the pusher pipe727 at the time of the forward movement to be constant in order toprotect the fixing clips 706 from being applied with excessively largeforce.

An elongated section receiving member 755 for forming the elongatedsection connection means 748 is disposed in the leading end of thehandle 743. A knob 756 arranged to be rotated integrally with the sheath703 is provided for the elongated section receiving member 755. Therotation of the knob 756 permits the direction of the clip holder 704with respect to the handle 743 to be determined arbitrarily. A flange703a is provided for the base portion of the sheath 703. A flange fixedplate 757 in the form of a pair of holding plates provided for theelongated section receiving member 755 is rotatively secured to theflange 703a.

Also a flange 727a is provided for the base portion of the pusher pipe727 inserted into the sheath 703. The base portion of the pusher pipe727 projects rearwards over the base portion of the sheath 703. Arestoration spring 758 is interposed between the flanges 703a and 727aso that a pusher moving means is formed.

The ultrasonic oscillator 745 has a vibration transmission member 759projecting forwards. The ultrasonic probe 710 is connected to theleading end of the vibration transmission member 759 through a screwconnection section 760. The ultrasonic probe 710 is made of metal, suchas stainless steel, duralumin or Ti6Al.4V and has a base portion formedinto a cylindrical shape. A portion of the ultrasonic probe 710 from anintermediate engaging hole 751 to the leading end is formed into a flatshape. The leading end of the ultrasonic probe 710 has a recess 752which is able to fit the shape of the base portion of the fixing clips706.

The operation of the surgical operation fixing apparatus having theabove-mentioned structure will now be described.

In an initial stage, the upper and lower holders 704a and 704b of theclip holder 704 are opened by the urging force of the opening spring713, as shown in FIG. 145. The leading end of the clip 706 supplied fromthe clip cartridge 707 is engaged to the U-groove 714 in a state wherethe two leg portions 706a of the fixing clips 706 are opened.

When the handle 743 of the operation section 701 is held and the lever744 is pulled in the above-mentioned state, the movement body 747 ismoved forwards through the pin 750 engaged to the engaging hole 751. Themovement of the movement body 747 is transmitted to the oscillatorholder 746 through the spring 752. Therefore, the ultrasonic oscillator745 is moved forwards so that the ultrasonic probe 710 connected to theultrasonic oscillator 745 through the vibration transmission member 759is moved forwards in the sheath 703 and therefore the fixing clip 706 ispushed forwards by the recess 752 formed in the leading end of theultrasonic probe 710. As a result, the clip 706 is moved along theU-groove 714 of each of the upper and lower holders 704a and 704b sothat the leading end of the leg portion 706a is brought into contactwith the stopper 715 and thus the clip 706 is stopped.

At this time, the pressing member 754 presses the pusher pipe 727through the projection member 753 attributable to the forward movementof the movement body 747. As a result, the pusher pipe 727 is movedforwards so that also the pusher 709 connected to the pusher pipe 727 ismoved forwards. However, since the leading end of the pusher 709 is notin contact with the pusher spring 722 at this time, the link mechanism720 is not operated so that the upper and lower holders 704a and 704bremain the opened state.

In the above-mentioned state, the surgical instrument is moved forwardstoward tubular tissue X required to be fixed so that the tubular tissueX is interposed between the leg portions 706a of the fixing clips 706held by the clip holder 704, as shown in FIG. 146.

When the lever 744 is further rotated, the pusher pipe 727 is movedforwards so that also the pusher 709 connected to the pusher pipe 727 ismoved forwards. As a result, the leading end of the pusher 709 isbrought into contact with the pusher spring 722. Thus, the slider 719 ismoved forwards through the pusher spring 722. Therefore, the baseportion of the upper and lower holders 704a and 704b is expanded by thelink mechanism 720 so that the upper and lower holders 704a and 704b arerotated against the urging force of the opening spring 713 in such amanner that the support-point pin 712 serves as the support point. Thus,the leading ends of the upper and lower holders 704a and 704b are closedso that the tubular tissue X is held between the upper and lower holders704a and 704b. When the pusher 709 is moved further forwards, theleading end of the pusher 709 is brought into contact with the steppedsection 724 so that the forward stroke of the pusher 709 is restricted.Therefore, the elasticity of the pusher spring 722 closes the upper andlower holders 704a and 704b with predetermined force. Thus, even if thelever 744 is pulled strongly, the clip 706 can be protected fromexcessively large force being applied.

If the ultrasonic oscillator 745 in the operation section 701 isoperated in the above-mentioned state, ultrasonic vibrations aretransmitted to the clip 706 through the ultrasonic probe 710. As aresult, the portion of the fixing clips 706 in which the leading ends ofthe leg portions 706a are in contact with each other is welded by theultrasonic waves so that the clip 706 is brought to a closed state and,therefore, the tubular tissue X held by the fixing clips 706 is fixed.

When the clip holder 704 is closed due to the forward movement of thepusher 709, the connection member 725 disposed at an intermediateposition of the pusher 709 is brought into contact with the leading endof the elongated hole 742 formed in the movable plate 736 of the clipcartridge 707. Therefore, the movable plate 736 is moved forwards sothat the blade 736a provided for the movable plate 736 forwards pressesthe rear end of the fixing clips 706 in the clip cartridge 707. As aresult, the frontmost clip 706 is moved to the frontmost position in theclip cartridge 707 so as to be supplied to the position of the opening739 formed in the side rail 733. Since the opening 739 has been closedby the leading end of the movable plate 736, the fixing clip 706 remainsthe state where it is pressed against the movable plate 736 by theloading spring 740.

When the tubular tissue X has been fixed and then the force for pullingthe lever 744 has been reduced, the restoration force of the spring 752rearwards moves the ultrasonic oscillator 745. Also the ultrasonic probe710 is moved rearwards so that the leading end of the ultrasonic probe710 is separated from the fixing clip 706 with which the fixingoperation has been completed. Also the restoration spring 758 iselongated due to the urging force, the pusher pipe 727 is movedrearwards. Thus, also the pusher 709 connected to the pusher pipe 727 ismoved rearwards. As a result, also the pusher spring 722 is elongatedand also the slider 719 is moved rearwards. Thus, the link mechanism 720opens the upper and lower holders 704a and 704b of the clip holder 704.

As a result of the above-mentioned operation, the connection member 725disposed at an intermediate position of the pusher 709 is brought intocontact with the rear end of the elongated hole 742 formed in themovable plate 736 of the clip cartridge 707. Therefore, the movableplate 736 is moved rearwards, thus causing the opening 739 to be opened.Thus, the clip 706 supplied to the frontmost position in the clipcartridge 707 is loaded into the clip holder 704 through the opening 739due to the spring force of the loading spring 740. Although force actsin a direction in which the blade 736a rearwards moves the clip 706 inthe clip cartridge 707 when the movable plate 736 is moved rearwards,the reward movement of the clip 706 can be prevented because the baseportion of the clip 706 is brought into contact with the blade 737aprovided for the fixed plate 737.

Then, the surgical instrument is returned to the initial state so thatfixing of the tubular tissue X is successively continued until theplural clips 706 accommodated in the clip cartridge 707 are used.

According to this embodiment, the following effects can be obtained.

That is, the ultrasonic probe 710 supplies the clip 706 to the clipholder 704, and the clip holder 704 is closed by the operation of theoperation section 701. Then, the clip 706 is welded by the ultrasonicprobe 710. Thus, the tubular tissue X, such as the blood vessel, canreliably be fixed. A simple operation for forwards moving the ultrasonicprobe 710 by the operation section 701 enables a sequence of operationsincluding loading of the fixing clip 706 into the clip holder 704,forward movement of the clip 706 in the clip cartridge 707, closing ofthe clip holder 704 and welding of the clip 706 to be performedsuccessively When the ultrasonic probe 710 is moved rearwards, a nextclip 706 can be supplied from the clip cartridge 707. Thus, theoperation can easily be performed and time required to complete theoperation can be shortened.

Since the clip 706 is made of the material which can be absorbed by theorganization, any foreign matter does not retain in the body. Since anylatch and hook for fixing the closed shape do not exist at the two endsof the clip 706, the blood vessel can easily be held. Since the two endsof the leg portion 706a of the clip 706 can be fixed by the ultrasonicwaves, a reliably closed state can be realized and strong fixing forcecan be obtained.

Since the clip does not require any latch or a hook, the size of theclip can be reduced. Since the clips are accommodated in the clipcartridge 707 in a straight line, the diameter of the elongation section702 can be reduced. Thus, the fixing operation can easily be performedeven in a narrow and deep portion which is required to be fixed. Theclips 706 can successively be used in an operation with an endoscopewhile inserting the elongation section 702 into the body cavity.Therefore, time required to complete the operation can be shortened.

Additional advantages and modifications will readily occur to thoseskilled in the art. Therefore, the invention in its broader aspects isnot limited to the specific details, representative devices, andillustrated examples shown and described herein. Accordingly, variousmodifications may be made without departing from the spirit or scope ofthe general inventive concept as defined by the appended claims andtheir equivalents.

What is claimed is:
 1. A surgical instrument for fixing organic tissuewith a suturing thread, comprising:an applicator for holding a threadfixing member, said applicator including thread fixing means for fixingthe thread fixing member to the suturing thread, and operation means foroperating the thread fixing means to suture the organic tissue with thesuturing thread; and forceps arranged to be inserted into a body cavitytogether with the thread fixing means, said forceps including holdingmeans for holding, when closed, one of the suturing thread and asuturing needle, and forceps-operating means for opening and closing theholding means.
 2. A surgical instrument according to claim 1, furthercomprising:first coupling means for coupling the thread fixing means andthe operation means with each other and for positioning the threadfixing means and the operation means at a far-end position and anear-end position, respectively; second coupling means for coupling theholding means and the forceps-operating means with each other and forpositioning the holding means and the forceps-operating means at thefar-end position and the near-end position, respectively; and aninsertion section incorporating the first and second coupling means andadapted to be inserted into the body cavity.
 3. A surgical instrumentaccording to claim 1, further comprising:at least one connecting memberfor connecting the applicator and the forceps such that the applicatorand the forceps extend in parallel to each other.
 4. A surgicalinstrument according to claim 1, whereinat least one of the applicatorand the forceps is movable in an axial direction.
 5. A surgicalinstrument according to claim 1, whereinthe thread fixing means weldsthe thread fixing member with ultrasonic waves to fix the thread fixingmember to the suturing thread.
 6. A surgical instrument according toclaim 5, whereinthe thread fixing means is fixed in a state where thethread fixing means is pressed against the thread fixing member untilthe thread fixing member is completely welded and fixed to the suturingthread with the ultrasonic waves.
 7. A surgical instrument according toclaim 1, whereinthe outer diameter of the insertion section is 10 mm to12 mm.
 8. A surgical instrument according to claim 1, whereintheapplicator and the forceps are connected such that decomposition ispermitted.
 9. A surgical instrument according to claim 1, wherein saidoperation means comprises means for moving the thread fixing means andthe forceps relative to each other and for closing the thread fixingmember to thereby connect the thread fixing member to the suturingthread.
 10. A surgical instrument according to claim 1, whereintheapplicator is able to rotate around an axis running parallel to alengthwise directional axis of the forceps.
 11. A surgical instrumentaccording to claim 1, whereinthe thread fixing member comprises asurgical clip having a first clamping portion, a second clampingportion, and a means for connecting the first clamping portion and thesecond clamping portion together, said surgical clip being made of athermoplastic resin which is softened when heated.
 12. A surgicalinstrument according to claim 1, whereinthe applicator comprises a clipapplicator including:a clip holder portion; clip container means forcontaining a plurality of surgical clips each having a first clampingportion, a second clamping portion, and a means for connecting the firstclamping portion and the second clamping portion together; clip supplymeans for feeding one of said surgical clips from the clip containermeans to the clip holder portion; means for operating the clip supplymeans; closing means for closing said first and second clamping portionsof said one of said surgical clips provided to the clip holder portion;ultrasonic oscillation means for inducing heat in said one of saidsurgical clips and for softening at least a part of said one of saidsurgical clips which is formed of a thermoplastic resin; and means fordeforming said softened thermoplastic resin of said one of said surgicalclips and for clamping said first and second clamping portions of saidone of said surgical clips together.
 13. A surgical instrument forfixing tubular tissue with a fixing clip, comprising:an elongationsection which is inserted into the body; an operation section disposedin a portion of an insertion section adjacent to an operator; a clipcartridge provided for the elongation section to accommodate a pluralityof fixing clips; a clip holder disposed at the leading end of theelongation section to hold and close the fixing clip; and an ultrasonicprobe disposed in the elongation section to weld the fixing clip held bythe clip holder with ultrasonic waves, wherein the ultrasonic probe isoperated when the operation section has been operated so that theleading end of the ultrasonic probe is brought into contact with thefixing clip to push out the fixing clip so as to supply the fixing clipto the clip holder.
 14. A surgical instrument according to claim 13,whereinthe fixing clip is welded by the ultrasonic probe after thefixing clip has been closed by the clip holder.
 15. A surgicalinstrument according to claim 13, whereinthe leading end of theultrasonic probe, which is brought into contact with the fixing clip, isformed in such a manner that the leading end of the ultrasonic probe isengaged to the rear end of the fixing clip.
 16. A surgical instrumentaccording to claim 13, whereinthe clip cartridge has a fixed platehaving a plurality of blades arranged to be brought into contact withthe fixing clips and a movable plate which is capable of movingforwards/rearwards in the lengthwise direction of the clip cartridge andwhich has a plurality of blades arranged to be brought into contact withthe fixing clips, and forward/rearward movement of the movable platewith respect to the fixed plate causes the fixing clip to be moved fromthe clip cartridge toward the clip holder.
 17. A surgical instrumentaccording to claim 16, whereinthe movable plate is movedforwards/rearwards attributable to the operation of the operationsection in a region between a forward position at which the fixing clippositioned at the frontmost position in the clip cartridge is set into aregion in which the fixing clip is able to come in contact with theleading end of the ultrasonic probe and a rearward position at which thefixing clip positioned at the frontmost position in the clip cartridgeis retracted from the region.
 18. A surgical instrument according toclaim 16, whereinthe clip holder has an opening/closing section forholding and closing the fixing clip, the elongation section has a holderopening/closing means arranged to be operated by the operation sectionto open/close the opening/closing section and the movable plate hasmeans for absorbing the difference between a stroke for supplying thefixing clip to the clip holder and a stroke for the clip cartridge. 19.A surgical instrument according to claim 13, whereinthe fixing clipcomprises a surgical clip having a first clamping portion, a secondclamping portion, and a means for connecting the first clamping portionand the second clamping portion together, said surgical clip being madeof a thermoplastic resin which is softened when heated.
 20. A surgicalinstrument for fixing tubular tissue with a fixing clip, comprising:anelongation section which is insertable into a body cavity; an operationsection disposed in a portion of an insertion section adjacent to anoperator; a clip cartridge provided for the elongation section toaccommodate a plurality of fixing clips; a clip holder disposed at aleading end of the elongation section to hold and close the fixing clip;supply means for supplying the fixing clip from the clip cartridge tothe clip holder; and means for maintaining constant a force of the clipholder for closing the fixing clip.
 21. A surgical instrument accordingto claim 20, further comprising:an ultrasonic probe disposed in theelongation section to weld the fixing clip held by the clip holder withultrasonic waves.
 22. A surgical instrument according to claim 21,whereinthe ultrasonic probe presses the fixing clip with predeterminedforce.
 23. A surgical instrument according to claim 20, whereinthe clipholder has, at the leading end thereof, a stopper for restrainingforward movement of the fixing clip.
 24. A surgical instrument accordingto claim 20, whereinthe clip holder has an opening/closing section forholding and closing the fixing clip, the opening/closing section beingopened/closed by a link mechanism.
 25. A surgical instrument accordingto claim 20, whereinthe fixing clip comprises a surgical clip having afirst clamping portion, a second clamping portion, and a means forconnecting the first clamping portion and the second clamping portiontogether, said surgical clip being made of a thermoplastic resin whichis softened when heated.
 26. A surgical instrument for fixing tubulartissue with a fixing clip, comprising:an elongation section which isinserted into the body; an operation section disposed in a portion of aninsertion section adjacent to an operator; a clip cartridge provided forthe elongation section to accommodate a plurality of fixing clips; aclip holder disposed at the leading end of the elongation section tohold and close the fixing clip; an ultrasonic probe disposed in thecentral portion of the elongation section to weld the fixing clip heldby the clip holder with ultrasonic waves; supply means disposed oneither side of the ultrasonic probe to supply the fixing clip from theclip cartridge to the clip holder; holder opening/closing means disposedon another side of the ultrasonic probe to open/close theopening/closing section of the clip holder; and a handle disposed in theoperation section to operate the holder opening/closing means.
 27. Asurgical instrument according to claim 26, whereinthe holderopening/closing means has a pipe section adjacent to an operator and abar section adjacent to the leading end, and the pipe section and thebar section are connected to each other at an intermediate position ofthe elongation section.
 28. A surgical instrument according to claim 26,whereinthe ultrasonic probe is in the form of a plate-like shape.
 29. Asurgical instrument according to claim 26, whereinthe elongation sectionis rotatable.
 30. A surgical instrument according to claim 26,whereinthe fixing clip comprises a surgical clip having a first clampingportion, a second clamping portion, and a means for connecting the firstclamping portion and the second clamping portion together, said surgicalclip being made of a thermoplastic resin which is softened when heated.